Provider Demographics
NPI:1942414735
Name:DAVIS, JAMES A JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3574 HABERSHAM AT NORTHLAKE
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:770-934-2339
Mailing Address - Fax:770-270-5491
Practice Address - Street 1:3574 HABERSHAM AT NORTHLAKE
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:770-934-2339
Practice Address - Fax:770-270-5491
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0105931223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
U31600Medicare UPIN
GA19NCBKMMedicare ID - Type Unspecified