Healthcare Provider Details

I. General information

NPI: 1518925973
Provider Name (Legal Business Name): CHRISTY LYNN DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 MASON AVE
DAYTONA BEACH FL
32117-4551
US

IV. Provider business mailing address

29 TWIN RIVER DR
ORMOND BEACH FL
32174-4834
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-2000
  • Fax: 386-274-2009
Mailing address:
  • Phone: 269-274-4431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME112112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: