Provider Demographics
NPI:1306878335
Name:DAVIS, JOHN WATSON JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WATSON
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:815 COX RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3453
Mailing Address - Country:US
Mailing Address - Phone:704-865-1700
Mailing Address - Fax:704-865-7948
Practice Address - Street 1:815 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3453
Practice Address - Country:US
Practice Address - Phone:704-865-1700
Practice Address - Fax:704-865-7948
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC104213363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ45253Medicare UPIN