MEDICARE: MRS. CHELSI GANUS DAVIS PA-C

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	363AS0400X	Surgical Physician Assistant	PA.1877	AL

General Provider Information

NPI Number	:	1225692098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHELSI GANUS DAVIS PA-C

Provider Business Mailing Address
First Line	:	1600 5TH AVE S
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-4658
Country	:	US
Telephone Number	:	205-578-1799
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 5TH AVE S
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-4658
Country	:	US
Telephone Number	:	205-578-1799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2019
Last Update Date	:	02/04/2026

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