Individual
CODY LYNN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
92 RATLIFF ST, LUCEDALE, MS 39452-6537
(601) 947-8181
(601) 947-1331
Mailing address
ONE MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
28362
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1Q0727
MEDICARE
MS
01
—
28362
MS MEDICAL LICENSE
MS
Enumeration date
04/04/2018
Last updated
06/15/2021
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