Active NPI
Walter Ray Davis Jr., D.D.S., M.S.D.
- Pediatric Dentistry
- Decatur, GA
National Provider Identifier
1639441876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 6206
- Practice address
- 1270 McConnell Dr Ste B
Decatur, GA 30033-3507 - Phone
- (404) 636-2501
- Fax
- (404) 636-2235
- NPI assigned
- Feb 3, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 6206 | GA | Primary |
Addresses
Primary practice location
1270 McConnell Dr Ste B
Decatur, GA 30033-3507
Mailing address
1270 McConnell Dr Ste B
Decatur, GA 30033-3507
Phone (404) 636-2501
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 |
|---|---|---|---|
| 6206 | GA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328227200000",
"number": "1639441876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1270 MCCONNELL DR STE B",
"city": "DECATUR",
"state": "GA",
"postal_code": "300333507",
"telephone_number": "404-636-2501",
"fax_number": "404-636-2235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1270 MCCONNELL DR STE B",
"city": "DECATUR",
"state": "GA",
"postal_code": "300333507",
"telephone_number": "404-636-2501",
"fax_number": "404-636-2235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "WALTER",
"middle_name": "RAY",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.D.S., M.S.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-03",
"last_updated": "2012-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "GA",
"license": "6206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.