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NPI Code Detail

MEDICARE: AMANDA T DAVIS M.D.

MEDICARE: AMANDA T DAVIS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician047729GA

General Provider Information

NPI Number : 1508861295
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA T DAVIS M.D.
Provider Business Mailing Address
First Line : 3300 BUCKEYE RD
Second Line : STE 178
City : ATLANTA
State : GA
Zip : 30341-4232
Country : US
Telephone Number : 770-458-6103
Fax Number : 770-234-0437
Provider Business Practice Location Address
First Line : 3300 BUCKEYE RD
Second Line : STE 178
City : ATLANTA
State : GA
Zip : 30341-4232
Country : US
Telephone Number : 770-458-6103
Fax Number : 770-234-0437
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 07/08/2007

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