Provider Demographics
NPI:1750384343
Name:DAVIS, PAUL KENT (PA-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:KENT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-766-0547
Mailing Address - Fax:336-766-0549
Practice Address - Street 1:105 STADIUM OAKS DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8962
Practice Address - Country:US
Practice Address - Phone:336-766-0547
Practice Address - Fax:336-766-0549
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101788363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2750266Medicare PIN
S70971Medicare UPIN