Provider Demographics
NPI:1467414953
Name:DAVIS, JOHN BLEVINS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BLEVINS
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 1:423 S SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-4576
Mailing Address - Country:US
Mailing Address - Phone:336-786-5144
Mailing Address - Fax:336-786-5146
Practice Address - Street 1:423 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030
Practice Address - Country:US
Practice Address - Phone:336-786-5144
Practice Address - Fax:336-786-5146
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC292252208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8927573Medicaid
NC8927573Medicaid
NC205787DOtherMEDICARE
NC340018882OtherRR MEDICARE
NC205787HMedicare ID - Type Unspecified
NC8927573Medicaid