MEDICARE: ICARE & ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1205488152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICARE & ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	7574 HIGHWAY 85
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-3447
Country	:	US
Telephone Number	:	770-681-0196
Fax Number	:	770-703-4006

Provider Business Practice Location Address
First Line	:	7574 HIGHWAY 85
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-3447
Country	:	US
Telephone Number	:	770-681-0196
Fax Number	:	770-703-4006

Authorized Official
Title or Position	:	OWNER & NP
Name	:	MR. JAMIL DAVIS
Credential	:	NP
Telephone Number	:	770-681-0196

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	07/11/2019

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Directions to “ICARE & ASSOCIATES, LLC ” Practice Location

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