Gary M Davis (NPI# 1912065251, PAC ID# 3870674658) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NEPHROLOGY.
| Nation Provider ID (NPI) | 1912065251 |
| PAC ID by PECOS | 3870674658 |
| Professional Enrollment ID | I20120426000574 |
| Full Name | Gary M Davis |
| Organization Legal Name | DIVERSIFIED RENAL GROUP LLC |
| Address |
6501 Dogwood View Pkwy Suite A Jackson MS 39213-7857 |
| Phone Number | 6018993340 |
| Gender | M |
| Medical School | MEHARRY MEDICAL COLLEGE SCHOOL OF MEDICINE |
| Graduation Year | 1982 |
| Primary Specialty | NEPHROLOGY |
| Secondary Specialties | INTERNAL MEDICINE |
| Group Practice PAC ID | 6406815299 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 250048 | ST DOMINIC-JACKSON MEMORIAL HOSPITAL |
| 250072 | MERIT HEALTH CENTRAL |
| 250102 | MISSISSIPPI BAPTIST MEDICAL CENTER |
| 250038 | MERIT HEALTH MADISON |
| Address | Phone | Organization |
|---|---|---|
| 6501 Dogwood View Pkwy, Suite A, Jackson, MS 39213-7857 | 6018993340 | DIVERSIFIED RENAL GROUP LLC |
| Organization Legal Name | DIVERSIFIED RENAL GROUP LLC |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Babatunde Olutade | Nephrology | Diversified Renal Group LLC | 6501 Dogwood View Pkwy, Suite A, Jackson, MS 39213-7857 |
| Hollye R Johnson | Nephrology | Diversified Renal Group LLC | 6501 Dogwood View Pkwy, Suite A, Jackson, MS 39213-7857 |
| Street Address |
6501 DOGWOOD VIEW PKWY SUITE A |
| City | JACKSON |
| State | MS |
| Zip | 39213-7857 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Babatunde Olutade | Nephrology | Diversified Renal Group LLC | 6501 Dogwood View Pkwy, Suite A, Jackson, MS 39213-7857 |
| Michael A Reddix | Internal Medicine | Reddix Family Clinic Pa | 6501 Dogwood View Pkwy, Suite B, Jackson, MS 39213-7857 |
| Hollye R Johnson | Nephrology | Diversified Renal Group LLC | 6501 Dogwood View Pkwy, Suite A, Jackson, MS 39213-7857 |
| Natalie Y Brookins-reddix | Internal Medicine | Reddix Family Clinic Pa | 6501 Dogwood View Pkwy, Suite B, Jackson, MS 39213-7857 |
| Kim Cooper | Nurse Practitioner | Reddix Family Clinic Pa | 6501 Dogwood View Pkwy, Suite B, Jackson, MS 39213-7857 |
| James B Moore | Nephrology | 6501 Dogwood View Pkwy, Suite A, Jackson, MS 39213-7857 | |
| Maurice Mcshan | Internal Medicine | Reddix Family Clinic Pa | 6501 Dogwood View Pkwy, Suite B, Jackson, MS 39213-7857 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amanda B. Greene | Nurse Practitioner | State of Mississippi-university of Mississippi Medical Center | 350 W Woodrow Wilson Dr, Cancer Institute, Jackson, MS 39213 |
| Jaleen D Sims | Obstetrics/gynecology | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Iesha Renee Williams | Nurse Practitioner | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Nobel D Attipoe | Obstetrics/gynecology | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Keila L Brown | Nurse Practitioner | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Tritresher Sizer | Nurse Practitioner | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Willye A Bell | Certified Nurse Midwife (cnm) | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Jan M Hausmann | Internal Medicine | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Sonia L Walker | Nurse Practitioner | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Barbara L Tapps | Nurse Practitioner | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Find all physicians in zip 39213 | |||
| City | JACKSON |
| Zip Code | 39213 |
| Specialty | NEPHROLOGY |
| City + Specialty | JACKSON + NEPHROLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.