Provider Demographics
NPI:1134007677
Name:DAVIS, CLINTON JR (NP)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 GARDEN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3540
Mailing Address - Country:US
Mailing Address - Phone:804-909-1228
Mailing Address - Fax:
Practice Address - Street 1:712 GARDEN VIEW DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3540
Practice Address - Country:US
Practice Address - Phone:804-909-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN334088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty