Provider Demographics
NPI:1316163215
Name:DAVIS, GEORGIA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1112 RICKARD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1017
Mailing Address - Country:US
Mailing Address - Phone:217-787-9540
Mailing Address - Fax:217-787-9183
Practice Address - Street 1:1331 BEDFORD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1987
Practice Address - Country:US
Practice Address - Phone:321-622-8114
Practice Address - Fax:321-622-4649
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2016-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-0786932084D0003X, 2084P0005X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE18931Medicare UPIN