Provider Demographics
NPI:1891717161
Name:DAVIS, HENRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:J
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 27690
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221-7690
Mailing Address - Country:US
Mailing Address - Phone:478-960-7747
Mailing Address - Fax:
Practice Address - Street 1:770 PINE ST STE 320
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2173
Practice Address - Country:US
Practice Address - Phone:478-633-1821
Practice Address - Fax:478-633-5180
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037783207VG0400X, 207V00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000696286NMedicaid
GA000696286OMedicaid
GAG24235Medicare UPIN
GA511I160136Medicare PIN
GA000696286OMedicaid