Provider Demographics
NPI:1497042386
Name:DAVIS, CORTLANDT (DPM)
Entity Type:Individual
Prefix:DR
First Name:CORTLANDT
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:CORTLANDT
Other - Middle Name:
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:125 HISTORY DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3969
Mailing Address - Country:US
Mailing Address - Phone:770-832-3546
Mailing Address - Fax:
Practice Address - Street 1:125 HISTORY DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3969
Practice Address - Country:US
Practice Address - Phone:770-832-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC646213ES0103X
GAPOD001318213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery