Active NPI
Roger Davis, PH.D.
- Psychologist
- Jacksonville, FL
National Provider Identifier
1174604987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY 5281
- Practice address
- 6817 Southpoint Pkwy Ste 904
904
Jacksonville, FL 32216-6293 - Phone
- (904) 332-9100
- Fax
- (904) 482-0647
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY 5281 | FL | Primary |
Addresses
Primary practice location
6817 Southpoint Pkwy Ste 904
904
Jacksonville, FL 32216-6293
Mailing address
6817 Southpoint Pkwy Ste 904
904
Jacksonville, FL 32216-6293
Phone (904) 332-9100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 5281 | FL | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Susan N Young Inc | Past | Accepting new patients | |
| Getalife, LLC | Psychologist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Neuropsychologist
- Jacksonville, FL
- NPI 1770788390
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174604987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6817 SOUTHPOINT PKWY STE 904",
"address_2": "904",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322166293",
"telephone_number": "904-332-9100",
"fax_number": "904-482-0647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6817 SOUTHPOINT PKWY STE 904",
"address_2": "904",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322166293",
"telephone_number": "904-332-9100",
"fax_number": "904-482-0647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "ROGER",
"name_prefix": "Mr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY 5281",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.