Provider Demographics
NPI:1285706309
Name:DAVIS, DIANE WATKINS (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:WATKINS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5201 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4501
Mailing Address - Country:US
Mailing Address - Phone:912-351-3030
Mailing Address - Fax:912-351-3039
Practice Address - Street 1:5201 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4501
Practice Address - Country:US
Practice Address - Phone:912-351-3030
Practice Address - Fax:912-351-3039
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2016-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA24798207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000264569AMedicaid
GAD39707Medicare UPIN