Healthcare Provider Details

I. General information

NPI: 1649499583
Provider Name (Legal Business Name): MELISSA DAWN DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 JOHN MADDOX DRIVE CONNECTOR NW
ROME GA
30165-1233
US

IV. Provider business mailing address

221 TECHNOLOGY PKWY NW
ROME GA
30165-1369
US

V. Phone/Fax

Practice location:
  • Phone: 762-235-3730
  • Fax: 706-234-9026
Mailing address:
  • Phone: 762-235-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number059141
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: