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Individual

DR. JACOB EVAN DAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD, MSC, CAQSM

Contact information

Practice address
740 FERST DRIVE, ATLANTA, GA 30332-2248
(404) 894-1420
Mailing address
57 EXECUTIVE PARK SOUTH NE, ATLANTA, GA 30329-2288

Taxonomy

Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
92855
GA

Other

Enumeration date
03/19/2019
Last updated
09/05/2023
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