Provider Demographics
NPI:1801901541
Name:DAVIS, RICHARD LEE (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
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:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-0009
Mailing Address - Country:US
Mailing Address - Phone:706-335-9081
Mailing Address - Fax:706-335-7194
Practice Address - Street 1:178 CADE ST
Practice Address - Street 2:SUITE C
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-1815
Practice Address - Country:US
Practice Address - Phone:706-376-6081
Practice Address - Fax:706-376-6444
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023725207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000291772QMedicaid
GA000291772PMedicaid
GA20BDCFFMedicare ID - Type Unspecified
D45182Medicare UPIN