| Doctor Name: | DR. GORDON THEODORE DAVIS |
| NPI Number: | 1932527843 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 29885 |
| Business Practice Address: | 3226 Maybank Highway Suite 1-a Barrier Islands Free Medical Clinics Johns Island, SC - 29455 |
| Business Phone Number: | 8432669800 |
| Business Fax Number: | |
| Mailing Address: | 7869 Gull Bay Drive, AWENDAW |
| State: | SC |
| Postal Code: | 29429 |
| Phone Number: | 8437371039 |
| Fax Number: | |
| NPI Enumeration Date: | 03/29/2014 |
| NPI Last Update Date: | 03/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 29885 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |