=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205728524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNE DAVIS NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2025
-----------------------------------------------------
Last Update Date | 11/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 MIMS RD
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30467-1994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-451-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 566 STILSON RD
-----------------------------------------------------
City | BROOKLET
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30415-5658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-405-7851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN-NP320237
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WE0003X
-----------------------------------------------------
Taxonomy Name | Emergency Registered Nurse
-----------------------------------------------------
License Number | RN320237
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------