Provider Demographics
NPI:1134345895
Name:DAVIS, RAY CHARLES (MD)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:CHARLES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4331 THURMOND TANNER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANC
Mailing Address - State:GA
Mailing Address - Zip Code:30542
Mailing Address - Country:US
Mailing Address - Phone:678-513-5744
Mailing Address - Fax:678-513-5831
Practice Address - Street 1:4331 THURMOND TANNER PARKWAY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANC
Practice Address - State:GA
Practice Address - Zip Code:30542
Practice Address - Country:US
Practice Address - Phone:678-513-5744
Practice Address - Fax:678-513-5831
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2009-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0352382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE51288Medicare UPIN