Healthcare Provider Details

I. General information

NPI: 1144473976
Provider Name (Legal Business Name): JESSICA MEREDITH DAVIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 TROUPE ST
AUGUSTA GA
30904-4799
US

IV. Provider business mailing address

5755 DUPREE DR
ATLANTA GA
30327-4309
US

V. Phone/Fax

Practice location:
  • Phone: 706-842-4113
  • Fax:
Mailing address:
  • Phone: 706-738-7246
  • Fax: 706-738-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: