Provider Demographics
NPI:1144269978
Name:DAVIS, LEE ANDREW JR (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANDREW
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 DOLLARWAY ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WHITEHALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-0026
Mailing Address - Country:US
Mailing Address - Phone:870-850-0800
Mailing Address - Fax:870-850-0801
Practice Address - Street 1:7500 DOLLARWAY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-3027
Practice Address - Country:US
Practice Address - Phone:870-850-0800
Practice Address - Fax:870-850-0801
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1966207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150107002Medicaid
AR5C879Medicare ID - Type UnspecifiedINDIVIDUAL MC#
AR150107002Medicaid
AR5M600Medicare ID - Type UnspecifiedGROUP MC#