Provider Demographics
NPI:1497722193
Name:DAVIS, WILLIAM H (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3795
Mailing Address - Country:US
Mailing Address - Phone:229-382-9733
Mailing Address - Fax:229-387-6161
Practice Address - Street 1:1007 GREENFIELD DR
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3795
Practice Address - Country:US
Practice Address - Phone:229-382-9733
Practice Address - Fax:229-387-6161
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0293202086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00427435AMedicaid
GA00427435CMedicaid
GA02BDJFDMedicare ID - Type UnspecifiedADDITIONAL MEDICARE PROV#
GA00427435AMedicaid
GAC70663Medicare UPIN