Healthcare Provider Details

I. General information

NPI: 1447146048
Provider Name (Legal Business Name): ANTHONY AYEBAKRO DAVIES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 BLACK RIVER ST
DECKERVILLE MI
48427-9440
US

IV. Provider business mailing address

3559 PINE ST
DECKERVILLE MI
48427-7703
US

V. Phone/Fax

Practice location:
  • Phone: 810-376-2885
  • Fax:
Mailing address:
  • Phone: 810-376-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number4301508627
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number4301508627
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number4301508627
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: