Healthcare Provider Details

I. General information

NPI: 1972788784
Provider Name (Legal Business Name): JAMES R DAVIS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 VISSING PARK RD
JEFFERSONVILLE IN
47130-5989
US

IV. Provider business mailing address

PO BOX 213
ALVATON KY
42122-0213
US

V. Phone/Fax

Practice location:
  • Phone: 270-202-2598
  • Fax: 270-622-2606
Mailing address:
  • Phone: 270-202-2598
  • Fax: 270-622-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number33498
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01024043A
License Number StateIN

VIII. Authorized Official

Name: DR. JAMES ROBBINS DAVIS
Title or Position: CEO
Credential: MD PSYCHIATRIST
Phone: 270-202-2598