Provider Demographics
NPI:1760432546
Name:DAVIS, JONATHAN D (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:50 MEDICAL PARK DR E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3401
Practice Address - Country:US
Practice Address - Phone:205-838-3134
Practice Address - Fax:205-838-3540
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO7912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009937433Medicaid
AL051534653OtherBLUE CROSS
AL009937436Medicaid
AL009937439Medicaid
AL515-34655OtherBLUE CROSS
AL009937437Medicaid
AL051534652OtherBLUE CROSS
AL051534657OtherBLUE CROSS
AL051534659OtherBLUE CROSS
AL009937324Medicaid
AL009937438Medicaid
AL051534654OtherBLUE CROSS
AL009937441Medicaid
AL009937442Medicaid
AL009938822Medicaid
AL051534656OtherBLUE CROSS
AL009937432Medicaid
AL051534660OtherBLUE CROSS
AL051536449OtherBLUE CROSS
AL7746861OtherAETNA
AL051534661OtherBLUE CROSS
AL051539872OtherBLUE CROSS
AL009937433Medicaid
AL009937442Medicaid
AL009938822Medicaid