Provider Demographics
NPI:1124890314
Name:DAVIS, JAMES ALEXANDER (ATC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALEXANDER
Last Name:DAVIS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N MORRISON AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-3428
Mailing Address - Country:US
Mailing Address - Phone:618-979-3648
Mailing Address - Fax:
Practice Address - Street 1:315 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1145
Practice Address - Country:US
Practice Address - Phone:618-979-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer