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Individual

CELESTE DAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CPNP

Contact information

Practice address
297 COOPER RD, LOGANVILLE, GA 30052-2518
(678) 381-2630
Mailing address
297 COOPER RD, LOGANVILLE, GA 30052-2518
(678) 381-2630

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN232264
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003215265A
GA
Enumeration date
11/06/2018
Last updated
08/04/2020
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