Healthcare Provider Details

I. General information

NPI: 1609738277
Provider Name (Legal Business Name): MR. CHRISTOPHER M DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 POSITIVE PL
GAINESVILLE GA
30501-4631
US

IV. Provider business mailing address

165 JACKSON DR
CHAGRIN FALLS OH
44022-1557
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-8102
  • Fax:
Mailing address:
  • Phone: 770-313-1232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: