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NPI Code Detail

MEDICARE: KELLY KIMBLE DAVIS MD

MEDICARE: KELLY KIMBLE DAVIS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1184328809
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY KIMBLE DAVIS MD
Provider Business Mailing Address
First Line : 604 E RAINTREE LN
Second Line :
City : GOLDSBORO
State : NC
Zip : 27534-8225
Country : US
Telephone Number : 919-222-3277
Fax Number :
Provider Business Practice Location Address
First Line : 1600 SW ARCHER RD
Second Line :
City : GAINESVILLE
State : FL
Zip : 32610-3003
Country : US
Telephone Number : 352-273-8234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2023
Last Update Date : 03/13/2026

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