=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730378290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLOYD DAVIS, MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2007
-----------------------------------------------------
Last Update Date | 03/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 N PARK DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30214-1645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-461-3060
-----------------------------------------------------
Fax | 770-460-9348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 128 N PARK DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30214-1645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-461-3060
-----------------------------------------------------
Fax | 770-460-9348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MR. JAMES THOMAS GAILMARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-461-3060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 008747
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------