MEDICARE: BETTY T DAVIS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0600X	Gerontology Registered Nurse	RN109114	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366391286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY T DAVIS RN

Provider Business Mailing Address
First Line	:	6049 COVINGTON HWY
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30035-3802
Country	:	US
Telephone Number	:	404-717-7409
Fax Number	:	770-922-8676

Provider Business Practice Location Address
First Line	:	6049 COVINGTON HWY
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30035-3802
Country	:	US
Telephone Number	:	404-717-7409
Fax Number	:	770-922-8676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	02/16/2026

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