Provider Demographics
NPI:1295105773
Name:DAVIS, CHRISTOPHER LAMAR (IDC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LAMAR
Last Name:DAVIS
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 CHERRY RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5011
Mailing Address - Country:US
Mailing Address - Phone:404-312-8228
Mailing Address - Fax:
Practice Address - Street 1:3665 CHERRY RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5011
Practice Address - Country:US
Practice Address - Phone:404-312-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman