Provider Demographics
NPI:1881856102
Name:DAVIS, SEAN GERMAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:GERMAINE
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 1:6095 PROFESSIONAL PKWY STE A210
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5611
Mailing Address - Country:US
Mailing Address - Phone:770-949-4188
Mailing Address - Fax:770-949-1614
Practice Address - Street 1:6095 PROFESSIONAL PKWY STE A210
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5611
Practice Address - Country:US
Practice Address - Phone:770-949-4188
Practice Address - Fax:770-949-1614
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82899207V00000X
VA0101246130207V00000X
NC2011-01122207V00000X
GA94237207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC828992Medicaid