Healthcare Provider Details

I. General information

NPI: 1861616153
Provider Name (Legal Business Name): LUIS R DAVILA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 FAIR RD STE 104
STATESBORO GA
30458-0822
US

IV. Provider business mailing address

1497 FAIR RD STE 104
STATESBORO GA
30458-0822
US

V. Phone/Fax

Practice location:
  • Phone: 912-486-1600
  • Fax: 912-871-3342
Mailing address:
  • Phone: 912-486-1600
  • Fax: 912-871-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25227
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number114505
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: