Healthcare Provider Details

I. General information

NPI: 1033618566
Provider Name (Legal Business Name): SHANA-KAE J DAVIS-CHANCE MSN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2018
Last Update Date: 02/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 OLD NORCROSS RD
LAWRENCEVILLE GA
30046-4317
US

IV. Provider business mailing address

2120 HUNTERS COVE DR
LAWRENCEVILLE GA
30044-5310
US

V. Phone/Fax

Practice location:
  • Phone: 770-513-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN175675
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: