Healthcare Provider Details

I. General information

NPI: 1194257931
Provider Name (Legal Business Name): CHERYL DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S MADISON ST SUITE 4
THOMASVILLE GA
31792-5495
US

IV. Provider business mailing address

118 S MADISON ST SUITE 4
THOMASVILLE GA
31792-5495
US

V. Phone/Fax

Practice location:
  • Phone: 229-289-5898
  • Fax:
Mailing address:
  • Phone: 229-289-5898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN192694
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number192694
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: