Provider Demographics
NPI:1396725859
Name:DAVIS, GEORGE H (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
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 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-493-7272
Mailing Address - Fax:423-493-7235
Practice Address - Street 1:325 N STATE OF FRANKLIN RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6056
Practice Address - Country:US
Practice Address - Phone:423-493-7272
Practice Address - Fax:423-493-7235
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB04584000207VM0101X, 207V00000X
TNDO1375207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1066521OtherHORIZON NJ HEALTH
NJ1363736OtherAETNA
01135405OtherAMERIGROUP
NJ01000667201OtherAMERICHOICE
NJ4721059OtherCIGNA
NJ7408005Medicaid
NJP00846747OtherRAILROAD MEDICARE
NJ01000667204OtherAMERICHOICE
NJ3708961OtherAETNA HMO
NJ60023219OtherHORIZON NJ HEALTH
TN3306590Medicaid
NJP3324940OtherOXFORD
NJP3801699OtherOXFORD
NJ7408004Medicaid
NJ0726960000OtherAMERIHEALTH
NJ4721059OtherCIGNA
NJC55363Medicare UPIN
NJ083630CA0Medicare PIN