| Mr Charles Seth Davis, CRNP | |
|
19250 N Mobile St, Citronelle, AL 36522-2122 | |
| (251) 866-7454 | |
| (251) 866-9121 |
| Full Name | Mr Charles Seth Davis |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner - Primary Care |
| Location | 19250 N Mobile St, Citronelle, Alabama |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699194522 | NPI | - | NPPES |
| 011846 | Other | AL | MEDICARE GROUP PAYEE NUMBER |
| 1063439065 | Other | AL | NPI GROUP PAYEE NUMBER |
| 630000013 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LP0200X | Nurse Practitioner - Pediatrics | 1-091410 (Alabama) | Secondary |
| 363LP2300X | Nurse Practitioner - Primary Care | 1-091410 (Alabama) | Primary |
| Entity Name | Childrens Urgent Care, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1124541438 PECOS PAC ID: 9234405408 Enrollment ID: O20171017000804 |
| Entity Name | Mobile County Board Of Health |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1063439065 PECOS PAC ID: 9931208386 Enrollment ID: O20180913000728 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Charles Seth Davis, CRNP 251 N Bayou St, Mobile, AL 36603-5827 Ph: (251) 690-8158 | Mr Charles Seth Davis, CRNP 19250 N Mobile St, Citronelle, AL 36522-2122 Ph: (251) 866-7454 |
Thaila Keodouangdy, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 19250 N Mobile St, Citronelle, AL 36522 Phone: 251-866-9126 | |
Ms. Hillary Macall Whitfield, CRNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 19140 S 3rd St, Citronelle, AL 36522 Phone: 251-866-0086 | |
Nancy Ursprung, CRNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 19250 N Mobile St, Citronelle, AL 36522 Phone: 251-866-7454 Fax: 251-866-9121 |