Provider Demographics
NPI:1992974901
Name:DAVIS, MARS F (PA-C)
Entity type:Individual
Prefix:
First Name:MARS
Middle Name:F
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 RUNNING DEER TRL
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-4607
Mailing Address - Country:US
Mailing Address - Phone:919-602-2065
Mailing Address - Fax:
Practice Address - Street 1:515 BARBOUR RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-7698
Practice Address - Country:US
Practice Address - Phone:919-602-2065
Practice Address - Fax:919-545-0560
Is Sole Proprietor?:No
Enumeration Date:2008-02-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101152363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMD1744564OtherDEA
NCMD1744564OtherDEA