Individual
TREVOR LAWTON DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3301 N OAK STREET EXT, VALDOSTA, GA 31605
(229) 242-6061
(229) 242-6151
Mailing address
3301 N OAK STREET EXT, VALDOSTA, GA 31605
(229) 242-6061
(229) 242-6151
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9150
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051253600
DRIVERS LICENSE
GA
Enumeration date
03/22/2019
Last updated
03/22/2019
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