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General NPI Number Information
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NPI Number | 1699837401
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Entity Type | Individual
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Provider Name | ELIZABETH MARIE DAVIS R PH
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 716 E 16TH AVE STE I
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City | CORDELE
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State | GA
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Zip | 31015-4517
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Country | US
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Telephone | 229-273-6660
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Fax | 229-271-3890
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Provider Business Mailing Address
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Address Line | 650 GRAND ST
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City | ASHBURN
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State | GA
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Zip | 31714-5021
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Country | US
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Telephone | 229-567-2764
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 013828
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License Number State | GA
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