Doctor Name: | MRS. JENNIFER LYNN DAVIS |
NPI Number: | 1568779601 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 1502 Hubert Pittman Rd Pendergrass, GA - 305672907 |
Business Phone Number: | 7066932650 |
Business Fax Number: | |
Mailing Address: | 1502 Hubert Pittman Rd, PENDERGRASS |
State: | GA |
Postal Code: | 305672907 |
Phone Number: | 7066932650 |
Fax Number: | |
NPI Enumeration Date: | 09/10/2010 |
NPI Last Update Date: | 09/10/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |