Provider Demographics
NPI:1689931727
Name:GEORGE A. DAVIS, M.D., P.A.
Entity Type:Organization
Organization Name:GEORGE A. DAVIS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-328-8369
Mailing Address - Street 1:800 ZEAGLER DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3827
Mailing Address - Country:US
Mailing Address - Phone:386-328-8369
Mailing Address - Fax:386-328-8006
Practice Address - Street 1:800 ZEAGLER DR
Practice Address - Street 2:SUITE 120
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3827
Practice Address - Country:US
Practice Address - Phone:386-328-8369
Practice Address - Fax:386-328-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043912207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
180002441OtherRR MEDICARE
7143688OtherAETNA
FL064445500Medicaid
180002441OtherRR MEDICARE