Healthcare Provider Details

I. General information

NPI: 1962484725
Provider Name (Legal Business Name): JOHN ANTHONY DAVIS PHD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 W 10TH AVE DIVISION OF INFECTIOUS DISEASE
COLUMBUS OH
43210-1228
US

IV. Provider business mailing address

700 ACKERMAN ROAD, SUITE 385 OSU INTERNAM MEDICINE, LLC
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-5667
  • Fax: 614-293-4556
Mailing address:
  • Phone: 614-947-3700
  • Fax: 614-947-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number092205
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: