Provider Demographics
NPI:1306819297
Name:DAVIS, DONALD S (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 HWY 39 N
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-1078
Mailing Address - Country:US
Mailing Address - Phone:601-485-8115
Mailing Address - Fax:601-485-3089
Practice Address - Street 1:5002 HWY 39 N
Practice Address - Street 2:BLDG A
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-1078
Practice Address - Country:US
Practice Address - Phone:601-485-8115
Practice Address - Fax:601-485-3089
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC48265Medicare UPIN