Provider Demographics
NPI:1831289883
Name:DAVIS, GARY LYNN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LYNN
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 HIGHWAY 74 N
Mailing Address - Street 2:SUITE1
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1470
Mailing Address - Country:US
Mailing Address - Phone:770-486-9169
Mailing Address - Fax:770-486-9145
Practice Address - Street 1:271 HIGHWAY 74 N
Practice Address - Street 2:SUITE1
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1470
Practice Address - Country:US
Practice Address - Phone:770-486-9169
Practice Address - Fax:770-486-9145
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU69309Medicare UPIN
GA35ZCFDDMedicare ID - Type Unspecified