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General NPI Number Information
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NPI Number | 1760875603
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Entity Type | Organization
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Legal Business Name | FAMILY ORTHOPEDIS, PC
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 930 FRANKLIN SPRINGS ST
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City | ROYSTON
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State | GA
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Zip | 30662-3908
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Country | US
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Telephone | 706-335-9081
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Fax | 706-335-7194
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Provider Business Mailing Address
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Address Line | PO BOX 463
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City | COMMERCE
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State | GA
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Zip | 30529-0009
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Country | US
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Telephone | 706-335-9081
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Fax | 706-335-7194
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD L DAVIS
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Credential | MD
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Telephone | 706-335-9081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 23725
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License Number State | GA
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