MEDICARE: MR. TIMOTHY MICHAEL DAVIS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP2201X	Ambulatory Care Registered Nurse	RN334940	GA
2	163WW0000X	Wound Care Registered Nurse	RN334940	GA
3	163WX0800X	Orthopedic Registered Nurse	RN334940	GA
4	163WX1500X	Ostomy Care Registered Nurse	RN334940	GA
5	163W00000X	Registered Nurse	RN334940	GA
6	146M00000X	Intermediate Emergency Medical Technician	I043820	GA
7	156F00000X	Technician/Technologist
8	163WN0800X	Neuroscience Registered Nurse	RN334940	GA
9	163WM0705X	Medical-Surgical Registered Nurse	RN334940	GA

General Provider Information

NPI Number	:	1346127065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY MICHAEL DAVIS RN

Provider Business Mailing Address
First Line	:	4519 HICKORY GROVE DR NW
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30102-3596
Country	:	US
Telephone Number	:	404-384-0160
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2212
Country	:	US
Telephone Number	:	404-686-4411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	08/18/2025

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