Individual
JAIME DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 DOCTORS DR, SUITE 201, DOUGLAS, GA 31533-2201
(912) 384-9460
(912) 393-1239
Mailing address
1100 WARD STREET EXT W, DOUGLAS, GA 31533-1902
(912) 384-1477
(912) 384-1470
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
054807
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
780359959A
—
GA
05
—
780359959D
—
GA
01
—
GRP7930
MEDICARE GROUP ID
GA
Enumeration date
02/28/2006
Last updated
07/02/2012
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