Healthcare Provider Details

I. General information

NPI: 1639406366
Provider Name (Legal Business Name): DALITA DAVIS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

329 CARLINGFORD CT SW
ATLANTA GA
30349-1297
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5260
  • Fax: 404-785-5243
Mailing address:
  • Phone: 404-304-2194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN160542
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN160542
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: