Individual
WENDY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
105 MILLS AVE STE 200, LAS VEGAS, NM 87701-4169
(505) 426-3795
Mailing address
2101 CENTRAL AVENUE, AUGUSTA, GA 30904
(706) 738-3359
(706) 738-0565
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
042057
GA
208600000X
Surgery Physician
Primary
MD2016-0938
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000868612B
—
GA
05
—
00868612C
—
GA
05
—
G40257
—
SC
Enumeration date
12/19/2005
Last updated
06/13/2023
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