Provider Demographics
NPI:1629700307
Name:DAVIS, JAMES EUGENE
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EUGENE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 SUMMERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7423
Mailing Address - Country:US
Mailing Address - Phone:334-297-3061
Mailing Address - Fax:334-297-0193
Practice Address - Street 1:5301 SUMMERVILLE RD
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7423
Practice Address - Country:US
Practice Address - Phone:334-297-3061
Practice Address - Fax:334-297-0193
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist