Active NPI
Charles Eugene Davis III, PA
- Physician Assistant
- London, KY
National Provider Identifier
1831537547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 272 London Mountain View Dr
London, KY 40741-6601 - Phone
- (606) 877-2850
- Fax
- (606) 877-2857
- NPI assigned
- Jun 5, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
272 London Mountain View Dr
London, KY 40741-6601
Mailing address
272 London Mountain View Dr
London, KY 40741-6601
Phone (606) 877-2850
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100246460 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378339200000",
"number": "1831537547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "272 LONDON MOUNTAIN VIEW DR",
"city": "LONDON",
"state": "KY",
"postal_code": "407416601",
"telephone_number": "606-877-2850",
"fax_number": "606-877-2857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "272 LONDON MOUNTAIN VIEW DR",
"city": "LONDON",
"state": "KY",
"postal_code": "407416601",
"telephone_number": "606-877-2850",
"fax_number": "606-877-2857"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "CHARLES",
"middle_name": "EUGENE",
"name_suffix": "III",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-05",
"last_updated": "2013-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100246460",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in London, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.