MEDICARE: SAVANNAH MARIE DAVIS NP

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	363LP2300X	Primary Care Nurse Practitioner	DAVI-AEXXP	NC

General Provider Information

NPI Number	:	1609630888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH MARIE DAVIS NP

Provider Business Mailing Address
First Line	:	200 HAWTHORNE LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2515
Country	:	US
Telephone Number	:	704-560-0185
Fax Number	:

Provider Business Practice Location Address
First Line	:	5324 GREAT WAGON RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3997
Country	:	US
Telephone Number	:	704-560-0185
Fax Number	:

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

Provider Enumeration Date	:	02/08/2024
Last Update Date	:	02/08/2024

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