Provider Demographics
NPI:1730478579
Name:DAVIS, JAMAL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 FOREST PKWY
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2210
Mailing Address - Country:US
Mailing Address - Phone:404-366-8420
Mailing Address - Fax:404-361-0684
Practice Address - Street 1:833 FOREST PKWY
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2210
Practice Address - Country:US
Practice Address - Phone:404-366-8420
Practice Address - Fax:404-361-0684
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist