Provider Demographics
NPI:1730802950
Name:DAVIS, LEA
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100925
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0925
Mailing Address - Country:US
Mailing Address - Phone:801-771-7771
Mailing Address - Fax:833-643-2775
Practice Address - Street 1:81 N 2000 W STE F2
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:UT
Practice Address - Zip Code:84015-8777
Practice Address - Country:US
Practice Address - Phone:385-430-8400
Practice Address - Fax:385-430-8401
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5184594-4405363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner