Healthcare Provider Details

I. General information

NPI: 1063482453
Provider Name (Legal Business Name): WILLIAM GIL DAVIS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 DECATUR ST
NEWTON MS
39345-2309
US

IV. Provider business mailing address

14994 W MAIN ST
LOUISVILLE MS
39339-2616
US

V. Phone/Fax

Practice location:
  • Phone: 601-683-3241
  • Fax: 601-683-3233
Mailing address:
  • Phone: 662-773-3494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number560
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: