MEDICARE: MR RIGHT REVEREND GREGORY KARL DAVIS

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
1	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1710387691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MR RIGHT REVEREND GREGORY KARL DAVIS

Provider Business Mailing Address
First Line	:	1075 PEACHTREE ST NE
Second Line	:	SUITE 3650
City	:	ATLANTA
State	:	GA
Zip	:	30309-3912
Country	:	US
Telephone Number	:	404-965-3974
Fax Number	:	404-965-3874

Provider Business Practice Location Address
First Line	:	1075 PEACHTREE ST NE
Second Line	:	SUITE 3650
City	:	ATLANTA
State	:	GA
Zip	:	30309-3912
Country	:	US
Telephone Number	:	404-965-3974
Fax Number	:	404-965-3874

Authorized Official
Title or Position	:	BISHOP
Name	:	MR. RT REVEREND GREGORY KARL DAVIS
Credential	:
Telephone Number	:	404-965-3974

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	08/28/2014

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