Provider Demographics
NPI:1659346955
Name:DAVIS, HARRIET NEELY (MD)
Entity Type:Individual
Prefix:
First Name:HARRIET
Middle Name:NEELY
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5815 BLAKENEY PARK DR STE 200B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5734
Practice Address - Country:US
Practice Address - Phone:704-316-5080
Practice Address - Fax:704-316-5085
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234595207Q00000X
NC200201452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2582Medicaid
NC1659346955Medicaid
VA005646928Medicaid
NC5907115Medicaid
H88006Medicare UPIN
VA005646928Medicaid
001964S54Medicare PIN