| Entity Name: | GEORGE A. DAVIS, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 10 Mar 1986 (39 years ago) |
| Document Number: | J03315 |
| FEI/EIN Number | 592647800 |
| Address: | 800 ZEAGLER DR, SUITE 120, PALATKA, FL, 32177 |
| Mail Address: | 800 ZEAGLER DR, SUITE 120, PALATKA, FL, 32177 |
| ZIP code: | 32177 |
| County: | Putnam |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689931727 | 2012-04-13 | 2012-04-19 | 800 ZEAGLER DR, SUITE 120, PALATKA, FL, 321773827, US | 800 ZEAGLER DR, SUITE 120, PALATKA, FL, 321773827, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 386-328-8369 |
| Fax | 3863288006 |
Authorized person
| Name | DR. GEORGE A DAVIS |
| Role | OWNER |
| Phone | 3863288369 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | ME0043912 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RR MEDICARE |
| Number | 180002441 |
| Issuer | AETNA |
| Number | 7143688 |
| Issuer | MEDICAID |
| Number | 064445500 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GEORGE A. DAVIS, M.D., P.A. PROFIT SHARING PLAN | 2009 | 592647800 | 2010-07-14 | GEORGE A. DAVIS, M.D., P.A. | 4 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 592647800 |
| Plan administrator’s name | GEORGE A. DAVIS, M.D., P.A. |
| Plan administrator’s address | 800 ZEAGLER DRIVE, SUITE 120, PALATKA, FL, 321773827 |
| Administrator’s telephone number | 3863288369 |
Signature of
| Role | Plan administrator |
| Date | 2010-07-14 |
| Name of individual signing | GEORGE DAVIS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| DAVIS SHERRY A | Agent | 800 ZEAGLER DR, PALATKA, FL, 32177 |
| Name | Role | Address |
|---|---|---|
| DAVIS GEORGE A | President | 800 ZEAGLER DR, PALATKA, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
