Provider Demographics
NPI:1407353246
Name:DAVIES, RYAN BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:BRADLEY
Last Name:DAVIES
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 1:1014 FORSYTH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2051
Mailing Address - Country:US
Mailing Address - Phone:478-633-7600
Mailing Address - Fax:478-633-7354
Practice Address - Street 1:1014 FORSYTH ST STE 100
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2051
Practice Address - Country:US
Practice Address - Phone:478-633-7600
Practice Address - Fax:478-633-7354
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89238208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics