Basic Information
| Provider Information | |||||||||
| NPI: | 1871791301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | LORANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 33369 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282333369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049162108 | ||||||||
| FaxNumber: | 7194733553 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 VAIL AVE STE 320 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043330741 | ||||||||
| FaxNumber: | 7043652073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2007 | ||||||||
| LastUpdateDate: | 07/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 53601 | CO | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 45235 | KY | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | LT16708 | ND | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 2019-01330 | NC | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.