Provider Demographics
NPI:1306814249
Name:DAVIS, CATHERINE D (PA/AA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA/AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 BELLGROVE PT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-7621
Mailing Address - Country:US
Mailing Address - Phone:478-731-4009
Mailing Address - Fax:
Practice Address - Street 1:624 BELLGROVE PT
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-7621
Practice Address - Country:US
Practice Address - Phone:478-731-4009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002988367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000477EMedicaid
GAP00097133OtherPALMETTO GBA
GA100000477CMedicaid
GA100000477FMedicaid
GA100000477GMedicaid
GA580628385OtherTRICARE
GA391018OtherWELLCARE
GAP00422622OtherRAILROAD MEDICARE
GA100000477FMedicaid
S73788Medicare UPIN