Healthcare Provider Details

I. General information

NPI: 1447743786
Provider Name (Legal Business Name): SHEENA NICHOLE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

245 E TRINITY PL UNIT 1358
DECATUR GA
30030-3491
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-3699
  • Fax:
Mailing address:
  • Phone: 404-604-8996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN211838
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN211838
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: