Individual provider Active NPI

Donna Davis, MD

  • Pediatrics Physician
  • Longview, TX
National Provider Identifier
1811974223
Registry record updated Sep 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
K5502 Issued in TX
Practice address
707 Hollybrook Dr
Longview, TX 75605-2410
Phone
(903) 757-6042
Fax
(903) 232-8298
NPI assigned
Dec 28, 2005
Last updated
Sep 23, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X K5502 TX Primary

Addresses

Primary practice location

707 Hollybrook Dr
Longview, TX 75605-2410

Mailing address

PO Box 610393
Dallas, TX 75261-0393
Phone (903) 291-6187

Other identifiers 1

IdentifierTypeStateIssuer
129237709MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110429000571 TX Practitioner - Pediatric Medicine 7416940333 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
K5502TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Clinics of Longview Pediatrics CurrentSince May 7, 2013 Accepting new patients
Associated Clinicians of East Texas Pediatrics CurrentSince Sep 1, 2017 Accepting new patients
Associated Clinicians of East Texas Past Accepting new patients
Longview Wellness Center Inc Pediatrics PastSince Jan 2, 2022 Accepting new patients
Longview Medical Center LP Past Accepting new patients

Locations

1009 N 4th St
Ste A
Longview, TX 75601
Phone (903) 757-3808

1107 E Marshall Ave
Longview, TX 75601
Phone (903) 212-4763

707 Hollybrook Dr
Longview, TX 75605
Phone (903) 232-8501

707 Hollybrook Dr
Ste 500
Longview, TX 75605
Phone (903) 232-8276

Interoperability endpoints

  • Direct secure messaging: donna.davis.1@23550.direct.athenahealth.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569196800000",
    "number": "1811974223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 610393",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752610393",
            "telephone_number": "903-291-6187",
            "fax_number": "903-237-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 HOLLYBROOK DR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052410",
            "telephone_number": "903-757-6042",
            "fax_number": "903-232-8298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "DONNA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-28",
        "last_updated": "2019-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "K5502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129237709",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.