Provider Demographics
NPI:1003829680
Name:DAVIS, EDNA F (MD)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:F
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EDNA
Other - Middle Name:DAVIS
Other - Last Name:WILKERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2007 OAK TREE COVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632
Mailing Address - Country:US
Mailing Address - Phone:662-429-8802
Mailing Address - Fax:662-429-8698
Practice Address - Street 1:2007 OAK TREE COVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632
Practice Address - Country:US
Practice Address - Phone:662-429-8802
Practice Address - Fax:662-429-8698
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM14539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07288289Medicaid
MSP00175855Medicare PIN
MSB59270Medicare UPIN