Charles King Davis Jr., MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

13889 Issued in KY

Practice address

755 Woodland Dr
Paducah, KY 42001-4677

Phone

(270) 442-1468

NPI assigned

Jan 28, 2013

Last updated

Jan 28, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Carolyn Albert Davis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Surgical Group PSC

  • Specialist
  • Paducah, KY
  • NPI 1780659946
  NPD (past)
• Vascular Specialists,PLLC

  • Specialist
  • Paducah, KY
  • NPI 1043248859
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359331200000",
    "number": "1154669026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 WOODLAND DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420014677",
            "telephone_number": "270-442-1468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 WOODLAND DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420014677",
            "telephone_number": "270-442-1468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "CHARLES",
        "middle_name": "KING",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-28",
        "last_updated": "2013-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KY",
            "license": "13889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "DAVIS",
            "middle_name": "ALBERT",
            "prefix": "MRS.",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Theodore Edwin Clyde Davies, M.D.
• Davis Drugs of Lone Oak Inc (Davis Drugs Lone Oak)
• Anthony K Davis, MD
• Bethany Ann Davis
• Brittney Lynn Davis, LPCA
• Cody Davis, PHARMD
• Marshall W Davis, RPH
• Mary A Davis, LCSW
• Portia Lynn Davis, LPCC
• Samantha Davis, M.S., CCC-SLP

• Surgery Physician in Paducah, KY
• Providers in Paducah, KY by specialty
• Surgery Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.