Provider Demographics
NPI:1013161322
Name:T. ALBERT DAVIS, M.D., PC
Entity type:Organization
Organization Name:T. ALBERT DAVIS, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-888-1011
Mailing Address - Street 1:1595 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 204 - #105
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9584
Mailing Address - Country:US
Mailing Address - Phone:770-888-1011
Mailing Address - Fax:770-888-6766
Practice Address - Street 1:634 PEACHTREE PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9782
Practice Address - Country:US
Practice Address - Phone:770-888-1011
Practice Address - Fax:770-888-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012079261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health