Provider Demographics
NPI:1356697684
Name:DAVIS HEALTH CARE SERVICES
Entity type:Organization
Organization Name:DAVIS HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:RAMONA
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-888-7304
Mailing Address - Street 1:1106 WHISPERING PINES RD
Mailing Address - Street 2:B
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3542
Mailing Address - Country:US
Mailing Address - Phone:229-888-7304
Mailing Address - Fax:229-888-7305
Practice Address - Street 1:1106 WHISPERING PINES RD
Practice Address - Street 2:B
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3542
Practice Address - Country:US
Practice Address - Phone:229-888-7304
Practice Address - Fax:229-888-7305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA568395341AMedicaid