Provider Demographics
NPI:1518925973
Name:DAVIS, CHRISTY LYNN (MD)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 TWIN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4834
Mailing Address - Country:US
Mailing Address - Phone:269-274-4431
Mailing Address - Fax:
Practice Address - Street 1:1430 MASON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4551
Practice Address - Country:US
Practice Address - Phone:386-274-2000
Practice Address - Fax:386-274-2009
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112112207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H060020OtherBCBSM
MI1518925973Medicaid
MI104994953Medicaid
MI0H06012026Medicare PIN
MI104994953Medicaid