Basic Information
| Provider Information | |||||||||
| NPI: | 1679564793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | CARTER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 PEACHTREE ST NE | ||||||||
| Address2: | SUITE 1620 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303082209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048857701 | ||||||||
| FaxNumber: | 4048857777 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 HOSPITAL DR | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | HIGHLANDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287417623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285264300 | ||||||||
| FaxNumber: | 8285268552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 07/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 10521 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 9500333 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 00138751C | 05 | GA | MEDICAID | 890687I-391 R | 05 | NC | MEDICAID |