Provider Demographics
NPI:1295895993
Name:DAVIS, GEORGE CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CHARLES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:279 3RD AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6205
Mailing Address - Country:US
Mailing Address - Phone:732-870-0650
Mailing Address - Fax:732-870-6950
Practice Address - Street 1:279 3RD AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6205
Practice Address - Country:US
Practice Address - Phone:732-870-0650
Practice Address - Fax:732-870-6950
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA031851207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2448505Medicare ID - Type Unspecified
NJD06434Medicare UPIN
NJDA445148Medicare ID - Type Unspecified