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General NPI Number Information
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NPI Number | 1174904148
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Entity Type | Individual
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Provider Name | JENNA SLAUGHTER DAVIS MD
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Gender | Female
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 2680 LAWRENCEVILLE HWY STE 100
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City | DECATUR
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State | GA
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Zip | 30033-2526
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Country | US
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Telephone | 770-515-9898
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Fax |
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Provider Business Mailing Address
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Address Line | 2680 LAWRENCEVILLE HWY STE 100
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City | DECATUR
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State | GA
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Zip | 30033-2526
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Country | US
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Telephone | 248-240-0988
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301107553
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 80692
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 80692
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License Number State | GA
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