Healthcare Provider Details

I. General information

NPI: 1366439093
Provider Name (Legal Business Name): ELLEN SATTERWHITE DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 SUMMIT CROSSING PL SUITE 150
GASTONIA NC
28054-2137
US

IV. Provider business mailing address

705 SUMMIT CROSSING PL SUITE 150
GASTONIA NC
28054-2137
US

V. Phone/Fax

Practice location:
  • Phone: 704-671-6300
  • Fax: 704-671-6307
Mailing address:
  • Phone: 704-671-6300
  • Fax: 704-671-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9800835
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: