Provider Demographics
NPI:1245436989
Name:DAVIS, REMONIA OULDS (PA-C)
Entity type:Individual
Prefix:
First Name:REMONIA
Middle Name:OULDS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 LANDOVER PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2115
Mailing Address - Country:US
Mailing Address - Phone:434-386-3541
Mailing Address - Fax:434-386-3577
Practice Address - Street 1:2215 LANDOVER PLACE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24506
Practice Address - Country:US
Practice Address - Phone:434-386-3541
Practice Address - Fax:434-386-3577
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110002517OtherMEDICAL LICENSE
VA1065778OtherPA CERTIFICATE NUMBER
VA0110002517OtherMEDICAL LICENSE