Provider Demographics
NPI:1902246945
Name:DAVIS, R TIM (NP-C)
Entity type:Individual
Prefix:
First Name:R
Middle Name:TIM
Last Name:DAVIS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:R.
Other - Middle Name:TIM
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 8147
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-8147
Mailing Address - Country:US
Mailing Address - Phone:706-320-2773
Mailing Address - Fax:706-596-4226
Practice Address - Street 1:2122 MANCHESTER EXPY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6878
Practice Address - Country:US
Practice Address - Phone:706-320-2773
Practice Address - Fax:706-596-4226
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-097301363LF0000X
GARN155517363LF0000X
FLAPRN9377694363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily