Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN201662 | GA |
NPI | 1003165788 |
---|---|
Provider Name | Lindsey Nye Davis |
First Address | Suwanee, GA 30024-1258 |
Second Address | Suwanee, GA 30024-1258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2012 |
Last Update Date | 10/09/2012 |