Provider Demographics
NPI:1134270374
Name:DAVIS, MATTHEW SCOTT (PA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SCOTT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4901 DAWN DR
Practice Address - Street 2:SUITE 2300
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-8287
Practice Address - Country:US
Practice Address - Phone:910-738-1065
Practice Address - Fax:910-738-5143
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2024-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC001000383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMD1415997OtherDEA