Provider Demographics
NPI:1083660732
Name:DAVIS, JOHN D IV (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:DAVIS
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2470 FLOWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232
Mailing Address - Country:US
Mailing Address - Phone:877-554-4257
Mailing Address - Fax:601-983-2845
Practice Address - Street 1:2470 FLOWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-936-0400
Practice Address - Fax:601-936-0401
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-10-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS16339207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126895Medicaid
MS630027OtherUHC
MS140007830OtherRAILROAD MEDICARE
MS5385608OtherAETNA
MSG78198Medicare UPIN
MS00126895Medicaid