Provider Demographics
NPI:1972838191
Name:DAVIS, MICHAEL LAMAR (PAA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAMAR
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PAA
Other - Prefix:
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Mailing Address - Street 1:4700 WATERS AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-8977
Mailing Address - Fax:912-350-7036
Practice Address - Street 1:247 S MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453-4605
Practice Address - Country:US
Practice Address - Phone:912-557-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1947367H00000X
GA5668367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant