Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Russell David Davis, PA

Individual provider Physician Assistant · NPI 1669119145

Russell David Davis, PA is a Physician Assistant in Clemmons, North Carolina. Qualified in 2022, 4 years ago. Practices with Novant Health Medical Group, LLC, a 2,410-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
4
Licensed in
NC
In the registry since
2022
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

7210 Village Medical Cir Ste 110
Clemmons, NC 27012-8041
Phone: (336) 893-2400
Fax: (336) 893-2410
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • Medical Center Blvd, Winston Salem, NC 27157-0001 — (336) 716-2011

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-12444 (NC)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1669119145
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 17, 2022
Last updated in NPPESJune 16, 2023
Certification dateJune 16, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Novant Health Medical Group, Llc — 2410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Clemmons