Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 4826 | NC |
Y | 213EG0000X | General Practice | 4826 | NC |
NPI | 1003873746 |
---|---|
Provider Name | Gwyn Davis |
First Address | Harrisburg, NC 28075-8356 |
Second Address | Charlotte, NC 28262-3381 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 08/07/2007 |