Provider Demographics
NPI:1235344805
Name:DAVIS, JAMES GORDON (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GORDON
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 NELSON BROGDON BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3478
Mailing Address - Country:US
Mailing Address - Phone:770-945-2119
Mailing Address - Fax:770-945-0979
Practice Address - Street 1:4520 NELSON BROGDON BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-3478
Practice Address - Country:US
Practice Address - Phone:770-945-2119
Practice Address - Fax:770-945-0979
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7856122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist