Provider Demographics
NPI:1982631768
Name:DAVIS, SAMUEL P III (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:P
Last Name:DAVIS
Suffix:III
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 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2707 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9458
Practice Address - Country:US
Practice Address - Phone:919-735-9146
Practice Address - Fax:919-735-0582
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070226A207Y00000X, 207YS0123X
NC9900469207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC040014729OtherPALMETTO GBA-RR MEDICARE
IN201036750Medicaid
NC891214VMedicaid
G16831Medicare UPIN
NC2277569Medicare ID - Type Unspecified
NC040014729OtherPALMETTO GBA-RR MEDICARE
INM400059703Medicare PIN
INP01192950Medicare PIN