Individual
MARYLOU LACOMB-DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
987 SAINT SEBASTIAN WAY, AUGUSTA, GA 30912-2613
(706) 721-9847
Mailing address
987 SAINT SEBASTIAN WAY, AUGUSTA, GA 30912-2613
(706) 721-9847
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
0024164874
VA
363LP0200X
Pediatric Nurse Practitioner
AC001077
MD
363LP0200X
Pediatric Nurse Practitioner
R207282
MD
363LP0200X
Pediatric Nurse Practitioner
Primary
RN250156
GA
363LP0200X
Pediatric Nurse Practitioner
RN960827
DC
Other
Enumeration date
10/08/2012
Last updated
01/28/2021
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