Provider Demographics
NPI:1518925973
Name:DAVIS, CHRISTY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
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:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:352-753-1727
Mailing Address - Fax:352-753-7567
Practice Address - Street 1:8485 SE 165TH MULBERRY LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5847
Practice Address - Country:US
Practice Address - Phone:352-753-1727
Practice Address - Fax:352-753-7567
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H060020OtherBCBSM
MI1518925973Medicaid
MI104994953Medicaid
MI0H06012026Medicare PIN
MI104994953Medicaid