Healthcare Provider Details

I. General information

NPI: 1922234699
Provider Name (Legal Business Name): JARED ANDREW DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEDICAL CENTER CIRCLE, SUITE 305
FISHERSVILLE VA
22939-0000
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939
US

V. Phone/Fax

Practice location:
  • Phone: 540-332-5168
  • Fax:
Mailing address:
  • Phone: 540-332-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101254098
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0101254098
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: