Healthcare Provider Details

I. General information

NPI: 1386866457
Provider Name (Legal Business Name): JOHN W. DAVIS, DC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 LAUREL ST
EAST ELLIJAY GA
30540
US

IV. Provider business mailing address

PO BOX 268
EAST ELLIJAY GA
30539-0005
US

V. Phone/Fax

Practice location:
  • Phone: 706-636-3303
  • Fax: 706-636-3316
Mailing address:
  • Phone: 706-636-3303
  • Fax: 706-636-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR002591
License Number StateGA

VIII. Authorized Official

Name: DR. JOHN W. DAVIS
Title or Position: PRESIDENT
Credential: D. C.
Phone: 706-636-3303