Provider Demographics
NPI:1194844365
Name:DAVIS, THOMAS ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALBERT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2542 BALLANTRAE CIR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6393
Mailing Address - Country:US
Mailing Address - Phone:770-888-1011
Mailing Address - Fax:770-888-6766
Practice Address - Street 1:634 PEACHTREE PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9782
Practice Address - Country:US
Practice Address - Phone:770-888-1011
Practice Address - Fax:770-888-6766
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0120792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD14583Medicare UPIN