=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710387691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MR RIGHT REVEREND GREGORY KARL DAVIS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2014
-----------------------------------------------------
Last Update Date | 08/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1075 PEACHTREE ST NE SUITE 3650
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30309-3912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-965-3974
-----------------------------------------------------
Fax | 404-965-3874
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1075 PEACHTREE ST NE SUITE 3650
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30309-3912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-965-3974
-----------------------------------------------------
Fax | 404-965-3874
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BISHOP
-----------------------------------------------------
Name | MR. RT REVEREND GREGORY KARL DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-965-3974
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------