Active NPI
Ryan Clifford Davis
- Pharmacist
- Jesup, GA
National Provider Identifier
1386256238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 032013
- Practice address
- 102 S 1St St
Jesup, GA 31545-1171 - Phone
- (912) 588-1035
- NPI assigned
- Aug 21, 2020
- Last updated
- Aug 21, 2020
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 032013 | GA | Primary |
Addresses
Primary practice location
102 S 1St St
Jesup, GA 31545-1171
Mailing address
3200 N Oak Street Ext
Valdosta, GA 31605-6473
Phone (229) 247-2553
Other practice location 1
3200 N Oak Street Ext
Valdosta, GA 31605-6473
Phone (229) 247-2553
Other practice location 2
4575 Altama Ave
Brunswick, GA 31520-3008
Phone (912) 261-2593
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 032013 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
102 S 1st St
Jesup, GA 31545
Phone (912) 588-1035
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597968000000",
"number": "1386256238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 N OAK STREET EXT",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316056473",
"telephone_number": "229-247-2553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 S 1ST ST",
"city": "JESUP",
"state": "GA",
"postal_code": "315451171",
"telephone_number": "912-588-1035"
}
],
"practiceLocations": [
{
"address_1": "3200 N Oak Street Ext",
"address_purpose": "LOCATION",
"city": "Valdosta",
"state": "GA",
"postal_code": "316056473",
"country_code": "US",
"telephone_number": "229-247-2553",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4575 Altama Ave",
"address_purpose": "LOCATION",
"city": "Brunswick",
"state": "GA",
"postal_code": "315203008",
"country_code": "US",
"telephone_number": "912-261-2593",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAVIS",
"first_name": "RYAN",
"middle_name": "CLIFFORD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-21",
"last_updated": "2020-08-21",
"certification_date": "2020-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "032013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jesup, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.