Healthcare Provider Details

I. General information

NPI: 1306954144
Provider Name (Legal Business Name): JAMES R DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19654 PROMISE RD
NOBLESVILLE IN
46060-9179
US

IV. Provider business mailing address

19654 PROMISE RD
NOBLESVILLE IN
46060-9179
US

V. Phone/Fax

Practice location:
  • Phone: 317-430-7636
  • Fax:
Mailing address:
  • Phone: 317-430-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number33498
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01024043A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: