MEDICARE: JAMIL EMAN DAVIS PMHNP

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	363LF0000X	Family Nurse Practitioner	188113	GA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN188113	GA

General Provider Information

NPI Number	:	1376882191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIL EMAN DAVIS PMHNP

Provider Business Mailing Address
First Line	:	7574 HIGHWAY 85
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-3447
Country	:	US
Telephone Number	:	229-395-8243
Fax Number	:	770-284-6612

Provider Business Practice Location Address
First Line	:	7574 HIGHWAY 85
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-3447
Country	:	US
Telephone Number	:	770-217-5168
Fax Number	:	770-284-6612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2013
Last Update Date	:	08/26/2019

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