Georgia Davis, M.D. and Associates L.L.C.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

0036078693 Issued in IL

Legal business name

GEORGIA DAVIS, M.D. AND ASSOCIATES L.L.C.

Practice address

1331 Bedford Dr
Suite 101
Melbourne, FL 32940-1987

Phone

(321) 622-8114

Fax

(321) 622-4649

NPI assigned

Dec 16, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Charles Joseph Mertz

Title

Business Manager

Phone

(217) 787-9540

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1292457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469491200000",
    "number": "1285937060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 RICKARD RD",
            "address_2": "SUITE B",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627041017",
            "telephone_number": "217-787-9540",
            "fax_number": "217-787-9183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 BEDFORD DR",
            "address_2": "SUITE 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329401987",
            "telephone_number": "321-622-8114",
            "fax_number": "321-622-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA DAVIS, M.D. AND ASSOCIATES L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-16",
        "last_updated": "2016-07-26",
        "status": "A",
        "authorized_official_last_name": "MERTZ",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "217-787-9540",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "0036078693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; 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.