Provider Demographics
NPI:1225692098
Name:DAVIS, CHELSI GANUS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHELSI
Middle Name:GANUS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHELSI
Other - Middle Name:
Other - Last Name:GANUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:521 MONTGOMERY HWY STE 117
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1876
Mailing Address - Country:US
Mailing Address - Phone:205-824-4441
Mailing Address - Fax:
Practice Address - Street 1:521 MONTGOMERY HWY STE 117
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1876
Practice Address - Country:US
Practice Address - Phone:205-824-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.1877363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty