Provider Demographics
NPI:1932527843
Name:DAVIS, GORDON THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:THEODORE
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 1:7869 GULL BAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:AWENDAW
Mailing Address - State:SC
Mailing Address - Zip Code:29429
Mailing Address - Country:US
Mailing Address - Phone:843-737-1039
Mailing Address - Fax:
Practice Address - Street 1:3226 MAYBANK HIGHWAY SUITE 1-A
Practice Address - Street 2:BARRIER ISLANDS FREE MEDICAL CLINICS
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455
Practice Address - Country:US
Practice Address - Phone:843-266-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29885208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice