Carolyn Davis, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ME 96897 Issued in FL

Practice address

36468 Emerald Coast Pkwy
Suite 8102, Old South Centre
Destin, FL 32541-4799

Phone

(850) 650-9500

NPI assigned

Apr 27, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Dr. Carolyn Church Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240790400000",
    "number": "1598909178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476647",
            "telephone_number": "850-243-8229",
            "fax_number": "850-863-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36468 EMERALD COAST PKWY",
            "address_2": "SUITE 8102, OLD SOUTH CENTRE",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325414799",
            "telephone_number": "850-650-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "CAROLYN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-27",
        "last_updated": "2009-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME 96897",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "050010",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AL",
            "license": "MD 27497",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "CHURCH",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Crest Custom Mobility LLC
• Karen Anne Criswell, SLP
• Casey Cummings, PHARMD, BCPPS
• Ashley T Cusson, ARNP FNP-C
• Orijane Alma Dalton, PHARMD
• John Taylor Matthew Davis, D.M.D.
• Mary Davis, LPTA
• Sheila Davis, MD, MSPH, PHD, JDC
• Alexander James Decubellis
• Deep Waters PLLC

• General Practice Physician in Destin, FL
• Providers in Destin, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.