Provider Demographics
NPI:1336212729
Name:DAVIS, ANNA CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:CHRISTINE
Last Name:DAVIS
Suffix:
Gender:F
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:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-0386
Mailing Address - Country:US
Mailing Address - Phone:985-951-7882
Mailing Address - Fax:985-951-7721
Practice Address - Street 1:69164 HIGHWAY 59
Practice Address - Street 2:SUITE 2
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-7782
Practice Address - Country:US
Practice Address - Phone:985-951-7882
Practice Address - Fax:985-951-7721
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013663207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1185116Medicaid
LAB63266Medicare UPIN
LA1185116Medicaid