Provider Demographics
NPI:1861492175
Name:DAVIS, SHELLEY CARTER JR (MD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:CARTER
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2801 N DECATUR RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5949
Mailing Address - Country:US
Mailing Address - Phone:404-296-3111
Mailing Address - Fax:404-297-7340
Practice Address - Street 1:2801 N DECATUR RD
Practice Address - Street 2:STE 300
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5949
Practice Address - Country:US
Practice Address - Phone:404-296-3111
Practice Address - Fax:404-297-7340
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA010522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055003002AMedicaid
GA11BDMSTMedicare ID - Type Unspecified
GA055003002AMedicaid