Provider Demographics
NPI:1649586074
Name:DAVIS, HENRY HAYS (AA - C)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:HAYS
Last Name:DAVIS
Suffix:
Gender:M
Credentials:AA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 VICTORIAN CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-6440
Mailing Address - Country:US
Mailing Address - Phone:404-512-6596
Mailing Address - Fax:
Practice Address - Street 1:1721 VICTORIAN CT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-6440
Practice Address - Country:US
Practice Address - Phone:404-512-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2061367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant