Provider Demographics
NPI:1619954153
Name:DAVIS, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4294 LOMAC ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3604
Practice Address - Country:US
Practice Address - Phone:334-274-9000
Practice Address - Fax:334-274-0857
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24900207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009919875Medicaid
51521459OtherBLUE CROSS
7823416OtherAETNA
09-10702OtherUNITED HEALTHCARE
1053595165OtherLOCATION NPI
14083OtherNCC/TYNET
51516056OtherBLUE CROSS
515 13453OtherBLUE CROSS
P00002536OtherRR MEDICARE
P00002536OtherRR MEDICARE
510I200037Medicare PIN
7823416OtherAETNA
H431Medicare PIN
51521459OtherBLUE CROSS
H429Medicare PIN
051513453Medicare PIN
14083OtherNCC/TYNET
AL009919875Medicaid
H430Medicare PIN
I048Medicare PIN