Healthcare Provider Details

I. General information

NPI: 1851215842
Provider Name (Legal Business Name): JENNIFER NICHOLE DAUGHTREY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 RUSSELL SMITH RD
SYCAMORE GA
31790-3571
US

IV. Provider business mailing address

373 RUSSELL SMITH RD
SYCAMORE GA
31790-3571
US

V. Phone/Fax

Practice location:
  • Phone: 229-326-7117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN235912
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: