Individual
KATY DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2080 CHILD ST, JACKSONVILLE, FL 32214-2575
(904) 542-9417
Mailing address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 449-2649
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
0101279685
VA
Other
Enumeration date
03/03/2022
Last updated
09/22/2023
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