Provider Demographics
NPI:1124410998
Name:ANDREW T DAVIES MD LLC
Entity Type:Organization
Organization Name:ANDREW T DAVIES MD LLC
Other - Org Name:DAVIES FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-528-7316
Mailing Address - Street 1:1114 STELLY LN
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5139
Mailing Address - Country:US
Mailing Address - Phone:337-528-7316
Mailing Address - Fax:337-528-7884
Practice Address - Street 1:1114 STELLY LN
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5139
Practice Address - Country:US
Practice Address - Phone:337-528-7316
Practice Address - Fax:337-528-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty