Healthcare Provider Details

I. General information

NPI: 1689628505
Provider Name (Legal Business Name): CALVIN P DAVIS JR. PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 EMBASSY PKWY STE 3
AKRON OH
44333-8320
US

IV. Provider business mailing address

PO BOX 72434
CLEVELAND OH
44192-0002
US

V. Phone/Fax

Practice location:
  • Phone: 330-670-4242
  • Fax: 330-670-4241
Mailing address:
  • Phone: 330-668-7428
  • Fax: 330-666-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.001487RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: