Provider Demographics
NPI:1437219367
Name:DAVIS, LAWTON C (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWTON
Middle Name:C
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 1:1028 LAKEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-0436
Mailing Address - Country:US
Mailing Address - Phone:478-275-6545
Mailing Address - Fax:478-275-6575
Practice Address - Street 1:2121 BELLEVUE RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2952
Practice Address - Country:US
Practice Address - Phone:478-275-6545
Practice Address - Fax:478-275-6575
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD39706Medicare UPIN
GAFLU 078Medicare ID - Type UnspecifiedMEDICARE NUMBER