Provider Demographics
NPI:1881876175
Name:DAVANZO, BARBARA (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:DAVANZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 FOLLINS LN
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-4263
Mailing Address - Country:US
Mailing Address - Phone:912-634-7714
Mailing Address - Fax:912-634-7734
Practice Address - Street 1:143 FOLLINS LN
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-4263
Practice Address - Country:US
Practice Address - Phone:912-634-7714
Practice Address - Fax:912-634-7734
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA501502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00923139AMedicaid
GA00923139AMedicaid
GAGRP7252Medicare PIN
GA26BDKBNMedicare PIN