Provider Demographics
NPI:1720137995
Name:DAVIS, SARA R (PA-C)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:350 N COX ST STE 27
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5514
Mailing Address - Country:US
Mailing Address - Phone:336-629-6500
Mailing Address - Fax:336-629-6900
Practice Address - Street 1:350 N COX ST STE 27
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5514
Practice Address - Country:US
Practice Address - Phone:336-629-6500
Practice Address - Fax:336-629-6900
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS14516Medicare UPIN