Provider Demographics
NPI:1700887809
Name:DAVIS, JAMES KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KENNETH
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:KENNETH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:585 WHITE POND DR
Mailing Address - Street 2:STE C
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1115
Mailing Address - Country:US
Mailing Address - Phone:330-836-8108
Mailing Address - Fax:330-836-9505
Practice Address - Street 1:585 WHITE POND DR
Practice Address - Street 2:STE C
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1115
Practice Address - Country:US
Practice Address - Phone:330-836-8108
Practice Address - Fax:330-836-9505
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH46941207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0557446Medicaid
OH0557446Medicaid
D31381Medicare UPIN