Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN191859 | GA |
NPI | 1033474242 |
---|---|
Provider Name | Mrs. Sarah Kelley Davis |
First Address | Buford, GA 30519-7173 |
Second Address | Athens, GA 30606-2179 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2012 |
Last Update Date | 13/07/2012 |