Healthcare Provider Details

I. General information

NPI: 1568376267
Provider Name (Legal Business Name): MELISSA ANN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 VERNON WHITE RD
WINTERVILLE NC
28590-8669
US

IV. Provider business mailing address

455 VERNON WHITE RD
WINTERVILLE NC
28590-8669
US

V. Phone/Fax

Practice location:
  • Phone: 704-305-3613
  • Fax:
Mailing address:
  • Phone: 704-305-3613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2026094249
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: