Healthcare Provider Details

I. General information

NPI: 1295008498
Provider Name (Legal Business Name): STACY C. DAVIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 WINTER ST
AUGUSTA GA
30904-4708
US

IV. Provider business mailing address

1450 WINTER ST
AUGUSTA GA
30904-4708
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-3371
  • Fax: 706-364-3380
Mailing address:
  • Phone: 706-364-3371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: REGINA HESTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-364-3371