Healthcare Provider Details

I. General information

NPI: 1891717161
Provider Name (Legal Business Name): HENRY J DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 PINE ST STE 320
MACON GA
31201-2173
US

IV. Provider business mailing address

PO BOX 27690
MACON GA
31221-7690
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-1821
  • Fax: 478-633-5180
Mailing address:
  • Phone: 478-960-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number037783
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number037783
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: