MEDICARE: MRS. JENNIFER LYNN DAVIS

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1568779601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LYNN DAVIS

Provider Business Mailing Address
First Line	:	1502 HUBERT PITTMAN RD
Second Line	:
City	:	PENDERGRASS
State	:	GA
Zip	:	30567-2907
Country	:	US
Telephone Number	:	706-693-2650
Fax Number	:

Provider Business Practice Location Address
First Line	:	1502 HUBERT PITTMAN RD
Second Line	:
City	:	PENDERGRASS
State	:	GA
Zip	:	30567-2907
Country	:	US
Telephone Number	:	706-693-2650
Fax Number	:

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

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	09/10/2010

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