Healthcare Provider Details

I. General information

NPI: 1275712986
Provider Name (Legal Business Name): JENNIFER LYNN DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 PHYSICIANS DR
WILMINGTON NC
28401-7335
US

IV. Provider business mailing address

1414 PHYSICIANS DR
WILMINGTON NC
28401-7335
US

V. Phone/Fax

Practice location:
  • Phone: 800-733-1476
  • Fax:
Mailing address:
  • Phone: 800-733-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2008-01817
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number200801817
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: