Organization
SPORA MEDICAL, PC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAKISA DAVIS (COM)
(773) 389-1899
Entity
Organization
Contact information
Practice address
4445 CORPORATION LN STE 264, VIRGINIA BEACH, VA 23462-3262
(773) 389-1899
(773) 466-9777
Mailing address
4445 CORPORATION LN STE 264, VIRGINIA BEACH, VA 23462-3262
(773) 389-1899
(773) 466-9777
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
374J00000X
Doula
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922695949
NPI
—
Enumeration date
12/23/2020
Last updated
06/11/2022
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