Healthcare Provider Details

I. General information

NPI: 1568826493
Provider Name (Legal Business Name): SUSAN ANGELINE DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 HILLCREST AVE
AUGUSTA GA
30909-3815
US

IV. Provider business mailing address

2813 HILLCREST AVE
AUGUSTA GA
30909-3815
US

V. Phone/Fax

Practice location:
  • Phone: 706-414-4938
  • Fax:
Mailing address:
  • Phone: 706-414-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number85252
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberBP10055814
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: