Healthcare Provider Details

I. General information

NPI: 1396163820
Provider Name (Legal Business Name): PRECISION FAMILY HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GLENDALE AVE
BAXLEY GA
31513-0244
US

IV. Provider business mailing address

24 GLENDALE AVE
BAXLEY GA
31513-0244
US

V. Phone/Fax

Practice location:
  • Phone: 912-614-6780
  • Fax:
Mailing address:
  • Phone: 912-614-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN120009
License Number StateGA

VIII. Authorized Official

Name: MRS. KIMBERLY FAULK DAVIS
Title or Position: OWNER
Credential: FNP
Phone: 912-614-6780