Healthcare Provider Details

I. General information

NPI: 1538144860
Provider Name (Legal Business Name): GEORGE EDWARD DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 ARSENAL STREET 11 SHS
AUGUSTA ME
04333-0001
US

IV. Provider business mailing address

28 EASTERN AVE
AUGUSTA ME
04330-5722
US

V. Phone/Fax

Practice location:
  • Phone: 207-624-4657
  • Fax: 207-287-6123
Mailing address:
  • Phone: 207-622-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number006900
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: