MEDICARE: DR. JASON EVAN DAVIS M.D.

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	2086S0129X	Vascular Surgery Physician	25MA09539300	NJ
2	208600000X	Surgery Physician	2017-00929	NC

General Provider Information

NPI Number	:	1285809475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON EVAN DAVIS M.D.

Provider Business Mailing Address
First Line	:	1905 ROCKGLEN LN
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2934 N ELM ST STE E
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-2987
Country	:	US
Telephone Number	:	910-739-0022
Fax Number	:	910-739-0079

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	11/18/2020

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