Doctor Name: | LARISSA DAVIS |
NPI Number: | 1063832731 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | RN197160 |
Business Practice Address: | 200 Doctors Dr Ste 201 Douglas, GA - 315332201 |
Business Phone Number: | 9123849460 |
Business Fax Number: | 9123931239 |
Mailing Address: | Po Box 1377, DOUGLAS |
State: | GA |
Postal Code: | 315341377 |
Phone Number: | 9123841477 |
Fax Number: | 9123841470 |
NPI Enumeration Date: | 04/22/2014 |
NPI Last Update Date: | 03/29/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN197160 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |