Healthcare Provider Details

I. General information

NPI: 1639865603
Provider Name (Legal Business Name): AUDREY DAVIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 E MAIN ST STE 3200
REYNOLDSBURG OH
43068-2819
US

IV. Provider business mailing address

8050 E MAIN ST STE 3200
REYNOLDSBURG OH
43068-2819
US

V. Phone/Fax

Practice location:
  • Phone: 614-434-5437
  • Fax: 614-434-5438
Mailing address:
  • Phone: 614-434-5437
  • Fax: 614-434-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.018640
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: