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General NPI Number Information
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NPI Number | 1558931402
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Entity Type | Individual
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Provider Name | RANDY ROBERT DAVIS PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 318 S WELBORN ST
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City | HINESVILLE
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State | GA
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Zip | 31313-3127
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Country | US
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Telephone | 912-332-5145
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Fax |
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Provider Business Mailing Address
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Address Line | 250 SUMMER HILL WAY
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City | RICHMOND HILL
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State | GA
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Zip | 31324-4531
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Country | US
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Telephone | 423-277-1458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10452
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License Number State | GA
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