Provider Demographics
NPI:1730378290
Name:FLOYD DAVIS, MD, PC
Entity type:Organization
Organization Name:FLOYD DAVIS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GAILMARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-461-3060
Mailing Address - Street 1:128 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1645
Mailing Address - Country:US
Mailing Address - Phone:770-461-3060
Mailing Address - Fax:770-460-9348
Practice Address - Street 1:128 N PARK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1645
Practice Address - Country:US
Practice Address - Phone:770-461-3060
Practice Address - Fax:770-460-9348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008747152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP839Medicare PIN
GA0782440001Medicare NSC