Provider Demographics
NPI:1417949066
Name:DAVIS, JANET ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:ELAINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANET
Other - Middle Name:DAVIS
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1348 WALTON WAY
Mailing Address - Street 2:SUITE 4300
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-5104
Mailing Address - Country:US
Mailing Address - Phone:706-722-4300
Mailing Address - Fax:706-722-7337
Practice Address - Street 1:1348 WALTON WAY
Practice Address - Street 2:SUITE 4300
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5104
Practice Address - Country:US
Practice Address - Phone:706-722-4300
Practice Address - Fax:706-722-7337
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030135207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF6211Medicare UPIN
GAF62110Medicare UPIN
GAF6211Medicare UPIN
GA00539734BMedicaid