Healthcare Provider Details

I. General information

NPI: 1053991455
Provider Name (Legal Business Name): FELISHA DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MARSHALL ST
RICHMOND VA
23298-5023
US

IV. Provider business mailing address

PO BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-827-0561
  • Fax: 804-827-1078
Mailing address:
  • Phone: 252-744-2803
  • Fax: 804-828-9783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number0101284663
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: