Healthcare Provider Details

I. General information

NPI: 1245319011
Provider Name (Legal Business Name): PRISCILLA ANN EDWARDS DAVIS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PROFESSIONAL DR # A SUITE 220
LAWRENCEVILLE GA
30045-7698
US

IV. Provider business mailing address

601 PROFESSIONAL DR # A SUITE 220
LAWRENCEVILLE GA
30045-7698
US

V. Phone/Fax

Practice location:
  • Phone: 678-985-8001
  • Fax: 678-985-8002
Mailing address:
  • Phone: 678-985-8001
  • Fax: 678-985-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN069177
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: