Provider Demographics
NPI:1790073872
Name:DAVIS, MILLARD ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:MILLARD
Middle Name:ANDREW
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:80 JESSE HILL DR SE
Mailing Address - Street 2:GRADY MEMORIAL HOSPITAL DEPARTMENT OF SURGERY
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-251-8745
Mailing Address - Fax:404-523-3931
Practice Address - Street 1:80 JESSE HILL DR SE
Practice Address - Street 2:GRADY MEMORIAL HOSPITAL DEPARTMENT OF SURGERY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-251-8745
Practice Address - Fax:404-523-3931
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA65956208600000X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program