Healthcare Provider Details

I. General information

NPI: 1740653781
Provider Name (Legal Business Name): AUDRA DAVIS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 PIERCE CHAPEL RD
CAIRO GA
39828-6766
US

IV. Provider business mailing address

281 PIERCE CHAPEL RD
CAIRO GA
39828-6766
US

V. Phone/Fax

Practice location:
  • Phone: 478-955-1527
  • Fax: 229-299-0068
Mailing address:
  • Phone: 478-955-1527
  • Fax: 229-299-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN160065
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: