Provider Demographics
NPI:1811970817
Name:DAVIS, GIGI WOOD (DO)
Entity type:Individual
Prefix:
First Name:GIGI
Middle Name:WOOD
Last Name:DAVIS
Suffix:
Gender:F
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 998
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-0998
Mailing Address - Country:US
Mailing Address - Phone:731-925-2766
Mailing Address - Fax:731-926-2772
Practice Address - Street 1:1010 WAYNE RD
Practice Address - Street 2:SUITE100
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-1596
Practice Address - Country:US
Practice Address - Phone:731-926-2766
Practice Address - Fax:731-926-2772
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3302613Medicare ID - Type UnspecifiedMEDICARE
TNE33075Medicare UPIN