=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114218302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JELANI GEMAR DAVIS PHARM.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2011
-----------------------------------------------------
Last Update Date | 04/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 HILLCREST PKWY
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31021-6340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-275-3655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 MARGIE DR APARTMENT #902
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31093-7600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-307-9596
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 024617
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------