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NPI Code Detail

MEDICARE: GEORGIA L DAVIS CNP

MEDICARE: GEORGIA L DAVIS CNP
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
1363LP0200XPediatric Nurse PractitionerNP00739OH

General Provider Information

NPI Number : 1700801834
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGIA L DAVIS CNP
Provider Business Mailing Address
First Line : 6835 BROADWAY AVE
Second Line : METROHEALTH BROADWAY HEALTH CENTER
City : CLEVELAND
State : OH
Zip : 44105-1313
Country : US
Telephone Number : 216-957-1850
Fax Number :
Provider Business Practice Location Address
First Line : 6835 BROADWAY AVE
Second Line : METROHEALTH BROADWAY HEALTH CENTER
City : CLEVELAND
State : OH
Zip : 44105-1313
Country : US
Telephone Number : 216-957-1850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 07/08/2007

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