Provider Demographics
NPI:1215951298
Name:DAVIS, CHANTY DENISE (MD)
Entity type:Individual
Prefix:
First Name:CHANTY
Middle Name:DENISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 EMERY HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3666
Mailing Address - Country:US
Mailing Address - Phone:478-741-2150
Mailing Address - Fax:478-741-2208
Practice Address - Street 1:165 EMERY HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3666
Practice Address - Country:US
Practice Address - Phone:478-741-2150
Practice Address - Fax:478-741-2208
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050097207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000911039DMedicaid
GA000911039EMedicaid
GA000911039CMedicaid
GACJ4042OtherRAILROAD MEDICARE GROUP
GAP00408060OtherRAILROAD MEDICARE
GAG42114Medicare UPIN
GA000911039CMedicaid