Healthcare Provider Details

I. General information

NPI: 1225173149
Provider Name (Legal Business Name): GEORGETOWN FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MARKET ST
GEORGETOWN DE
19947-1440
US

IV. Provider business mailing address

201 W MARKET ST
GEORGETOWN DE
19947-1440
US

V. Phone/Fax

Practice location:
  • Phone: 302-856-3171
  • Fax: 302-856-2330
Mailing address:
  • Phone: 785-341-4569
  • Fax: 302-856-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0006044
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0006045
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-00000702
License Number StateDE

VIII. Authorized Official

Name: RYAN SCOT DAVIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 785-341-4569