Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN057110 NP | GA |
NPI | 1003008475 |
---|---|
Provider Name | Jennifer Kay Davis |
First Address | Douglas, GA 31533-7150 |
Second Address | Douglas, GA 31533-2832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 07/01/2016 |