MEDICARE: CARL A 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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1194668004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL A DAVIS MD

Provider Business Mailing Address
First Line	:	4701 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1607
Country	:	US
Telephone Number	:	936-305-4155
Fax Number	:	936-305-3036

Provider Business Practice Location Address
First Line	:	4701 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1607
Country	:	US
Telephone Number	:	936-305-4155
Fax Number	:	936-305-3036

Authorized Official
Title or Position	:	OWNER
Name	:	CARL A DAVIS
Credential	:	MD
Telephone Number	:	936-305-4155

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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