Healthcare Provider Details

I. General information

NPI: 1356336606
Provider Name (Legal Business Name): JAMES ROSS DAVIS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 JESSE JEWELL PKWY SE GAINESVILLE
GAINESVILLE GA
30501-3722
US

IV. Provider business mailing address

2709 LEGISLATIVE LN
BUFORD GA
30519-8037
US

V. Phone/Fax

Practice location:
  • Phone: 770-539-9001
  • Fax: 770-539-9217
Mailing address:
  • Phone: 770-540-7441
  • Fax: 770-539-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000315
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: