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General NPI Number Information
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NPI Number | 1386126290
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Entity Type | Individual
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Provider Name | REGINA DAVIS NP
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Gender | Female
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 480 N MAIN ST STE 202
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City | ALPHARETTA
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State | GA
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Zip | 30009-8386
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Country | US
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Telephone | 678-619-1974
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Fax | 678-619-1975
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Provider Business Mailing Address
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Address Line | 3218 CRANBERRY LN
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City | BUFORD
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State | GA
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Zip | 30519-4186
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Country | US
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Telephone | 770-856-3372
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN156624
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License Number State | GA
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