Healthcare Provider Details

I. General information

NPI: 1972684090
Provider Name (Legal Business Name): VERSIE ELDER DAVIS RN,CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 GWINNETT DR
LAWRENCEVILLE GA
30045-8444
US

IV. Provider business mailing address

915 HILLSIDE MILL DR
GRAYSON GA
30017-1905
US

V. Phone/Fax

Practice location:
  • Phone: 770-339-5060
  • Fax:
Mailing address:
  • Phone: 770-513-3519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN062833
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: