Individual
MS. EJUAN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HAIR LOSS SPECIALIST
Contact information
Practice address
5043 JIMMY LEE SMITH PKWY, HIRAM, GA 30141-2733
(404) 834-0396
Mailing address
19 CENTENNIAL LN, DALLAS, GA 30132-0256
(404) 834-0396
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
1744P3200X
Prosthetics Case Management
Primary
—
—
246Z00000X
Other Specialist/Technologist
—
—
Other
Enumeration date
08/23/2017
Last updated
07/21/2022
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