Provider Demographics
NPI:1407225451
Name:MACON - DAVIS, BRITTANY DENISE (PA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DENISE
Last Name:MACON - DAVIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7135
Mailing Address - Country:US
Mailing Address - Phone:919-819-0918
Mailing Address - Fax:
Practice Address - Street 1:1021 MOREHEAD MEDICAL DR OFC 2011
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2990
Practice Address - Country:US
Practice Address - Phone:919-819-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05946363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1407225451Medicaid
SC2408PAMedicaid
NCNCQ292BMedicare PIN
NCNCQ292AMedicare PIN
SC2408PAMedicaid
NC1407225451Medicaid