Provider Demographics
NPI:1225050750
Name:DAVIS, JAMES WILSON JR (MD, FACS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILSON
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 D JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1687
Mailing Address - Country:US
Mailing Address - Phone:404-252-0301
Mailing Address - Fax:404-255-3398
Practice Address - Street 1:993 D JOHNSON FERRY RD
Practice Address - Street 2:SUITE 470
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1687
Practice Address - Country:US
Practice Address - Phone:404-252-0301
Practice Address - Fax:404-255-3398
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE95525Medicare UPIN