Healthcare Provider Details

I. General information

NPI: 1265369433
Provider Name (Legal Business Name): SHIRTIA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 ENTERPRISE PATH STE 206
HIRAM GA
30141-2654
US

IV. Provider business mailing address

79 AMBERLEE PL
DOUGLASVILLE GA
30134-5900
US

V. Phone/Fax

Practice location:
  • Phone: 770-681-0517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN310372
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: