Provider Demographics
NPI:1033347273
Name:DAVIS, AMELIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 W GOLD NUGGET LN
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-6256
Mailing Address - Country:US
Mailing Address - Phone:928-316-2688
Mailing Address - Fax:928-668-4270
Practice Address - Street 1:1901 W GOLD NUGGET LN
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-6256
Practice Address - Country:US
Practice Address - Phone:928-316-2688
Practice Address - Fax:928-668-4270
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1089702084P0800X
CAA1385362084P0800X
AZ503492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008991200Medicaid
FLHL278ZMedicare PIN