Provider Demographics
NPI:1154669026
Name:DAVIS, CHARLES KING JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KING
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:ALBERT
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:755 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4677
Mailing Address - Country:US
Mailing Address - Phone:270-442-1468
Mailing Address - Fax:
Practice Address - Street 1:755 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4677
Practice Address - Country:US
Practice Address - Phone:270-442-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13889208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery