Provider Demographics
NPI:1245319011
Name:DAVIS, PRISCILLA ANN EDWARDS (CNP)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANN EDWARDS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 PROFESSIONAL DR # A
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7698
Mailing Address - Country:US
Mailing Address - Phone:678-985-8001
Mailing Address - Fax:678-985-8002
Practice Address - Street 1:601 PROFESSIONAL DR # A
Practice Address - Street 2:SUITE 220
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7698
Practice Address - Country:US
Practice Address - Phone:678-985-8001
Practice Address - Fax:678-985-8002
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN069177363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology