MEDICARE: WENDY 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	208600000X	Surgery Physician	042057	GA
2	208600000X	Surgery Physician	MD2016-0938	NM

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962488288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY DAVIS MD

Provider Business Mailing Address
First Line	:	2101 CENTRAL AVENUE
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904
Country	:	US
Telephone Number	:	706-738-3359
Fax Number	:	706-738-0565

Provider Business Practice Location Address
First Line	:	105 MILLS AVE STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4169
Country	:	US
Telephone Number	:	505-426-3795
Fax Number	:

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	06/13/2023

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Directions to “ WENDY DAVIS MD” Practice Location

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