Provider Demographics
NPI:1205901410
Name:DAVIS, WILLETTE CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:WILLETTE
Middle Name:CHRISTINE
Last Name:DAVIS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 ADAMS LAKE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3366
Mailing Address - Country:US
Mailing Address - Phone:678-305-0760
Mailing Address - Fax:
Practice Address - Street 1:612 ADAMS LAKE BLVD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3366
Practice Address - Country:US
Practice Address - Phone:678-305-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD25852207R00000X, 208M00000X
IN01065258A207R00000X
GA42040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG63766Medicare ID - Type Unspecified