Healthcare Provider Details

I. General information

NPI: 1316121312
Provider Name (Legal Business Name): MAKITA DAVEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 CEDAR MIST DR
HAMPTON GA
30228-3494
US

IV. Provider business mailing address

1031 CEDAR MIST DR
HAMPTON GA
30228-3494
US

V. Phone/Fax

Practice location:
  • Phone: 678-919-1042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN262753
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number290044-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: