Basic Information
| Provider Information | |||||||||
| NPI: | 1811989411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | ALISA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALLAIRE | ||||||||
| OtherFirstName: | ALISA | ||||||||
| OtherMiddleName: | DAVIS | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705334786 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 JESSE JEWELL PKWY SE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305013834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782074373 | ||||||||
| FaxNumber: | 7705334727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 04/12/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 039033 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208M00000X | 039033 | GA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 039033 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01357688 | 01 | GA | AMERIGROUP | OTHER | 000661152H | 05 | GA | MEDICAID | 5095745 | 01 | GA | AETNA | OTHER | 000661152G | 05 | GA | MEDICAID | 000661152M | 05 | GA | MEDICAID | 000661152F | 05 | GA | MEDICAID | 52575335 | 01 | GA | BCBS | OTHER | 6830817 | 01 | GA | CIGNA | OTHER | 000661152D | 05 | GA | MEDICAID | 000661152E | 05 | GA | MEDICAID | 1811989411 | 01 | GA | UNITED HEALTHCARE | OTHER | 325763 | 01 | GA | WELLCARE | OTHER | 01357686 | 01 | GA | AMERIGROUP | OTHER |