Individual
LOGOI B DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
715 QUEEN CITY PKWY, GAINESVILLE, GA 30501-4348
(770) 531-5115
(770) 531-5116
Mailing address
3945 LAWRENCEVILLE HWY NW, LILBURN, GA 30047-2817
(678) 380-8353
(378) 380-8388
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3158
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
387169911C
—
GA
05
—
387169911D
—
GA
05
—
387169911E
—
GA
05
—
387169911F
—
GA
05
—
387169911G
—
GA
05
—
387169911H
—
GA
Enumeration date
07/17/2006
Last updated
08/21/2014
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