Individual
KELLY R DAVILLIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
060168
GA
208000000X
Pediatrics Physician
Primary
MD.024912
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1420565
—
LA
05
—
1899964650A
—
GA
01
—
MD.024912
LOUISIANA STATE BOARD MEDICAL EXAMINERS
LA
Enumeration date
08/26/2005
Last updated
11/18/2024
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