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General NPI Number Information
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NPI Number | 1750764932
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Entity Type | Individual
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Provider Name | KATHLEEN DAVIS NP-C
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Gender | Female
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 120 OAKSIDE CT
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City | CANTON
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State | GA
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Zip | 30114-2471
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Country | US
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Telephone | 678-880-8770
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Fax |
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Provider Business Mailing Address
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Address Line | 2765 LAWRENCE MILL RUN
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City | MARIETTA
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State | GA
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Zip | 30068-3158
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Country | US
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Telephone | 678-777-4720
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | RN068065
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN068065
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License Number State | GA
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