Provider Demographics
NPI:1053406173
Name:DAVIS, JOHN JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5577 CHALKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-2171
Mailing Address - Country:US
Mailing Address - Phone:205-853-3533
Mailing Address - Fax:205-856-3808
Practice Address - Street 1:5577 CHALKVILLE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-2171
Practice Address - Country:US
Practice Address - Phone:205-853-3533
Practice Address - Fax:205-856-3808
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051507168OtherBLUE CROSS PROVIDER NUMBE
AL051507168Medicare ID - Type Unspecified
AL051507168OtherBLUE CROSS PROVIDER NUMBE