MEDICARE: DR. MITCHELL GORDON 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	207RC0000X	Cardiovascular Disease Physician	035030	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528047149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL GORDON DAVIS MD

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S ENOTA DR NE STE 100
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3466
Country	:	US
Telephone Number	:	770-534-2020
Fax Number	:	770-534-8025

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	10/06/2020

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Directions to “ DR. MITCHELL GORDON DAVIS MD” Practice Location

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