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Individual
JAQUELINE MARGARET DAVIS
Active
Individual
JAQUELINE MARGARET DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN143842
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01067491
AMERIGROUP
GA
01
—
404178
WELLCARE
GA
01
—
50BBLLG
OLD MEDICARE PTAN
GA
05
—
593466638A
—
GA
01
—
P00394154
RR MEDICARE
GA
Enumeration date
07/24/2006
Last updated
06/14/2019
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