Basic Information
| Provider Information | |||||||||
| NPI: | 1083970560 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | PEAVY ENNEKING | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 PENNSYLVANIA AVE NW | ||||||||
| Address2: | THE GW MEDICAL FACULTY ASSOCIATES | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200373201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027413000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2150 PENNSYLVANIA AVE NW | ||||||||
| Address2: | THE GW MEDICAL FACULTY ASSOCIATES | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200373201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027413000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2012 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD042052 | DC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.