Provider Demographics
NPI:1316020498
Name:DAVIS, JAMES GRADY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GRADY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 10TH AVE S
Mailing Address - Street 2:SUITE 509
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1200
Mailing Address - Country:US
Mailing Address - Phone:205-933-7847
Mailing Address - Fax:205-933-7832
Practice Address - Street 1:2700 10TH AVE S
Practice Address - Street 2:SUITE 509
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1200
Practice Address - Country:US
Practice Address - Phone:205-933-7847
Practice Address - Fax:205-933-7832
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL5711174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
510-09577OtherBLUE CROSS BLUE SHIELD
C75350Medicare UPIN