Healthcare Provider Details

I. General information

NPI: 1972062677
Provider Name (Legal Business Name): JENNIFER MARIE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WATERS AVE
SAVANNAH GA
31404-6220
US

IV. Provider business mailing address

132 SUMMER WINDS DR
SAVANNAH GA
31410-2927
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-1537
  • Fax: 912-350-0010
Mailing address:
  • Phone: 912-373-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN153917
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN153917
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: