Provider Demographics
NPI:1003455874
Name:DAVIS-BOGAN, TOREY CHARLISE (SA-C, CST)
Entity Type:Individual
Prefix:MRS
First Name:TOREY
Middle Name:CHARLISE
Last Name:DAVIS-BOGAN
Suffix:
Gender:F
Credentials:SA-C, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 ROME CT SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4423
Mailing Address - Country:US
Mailing Address - Phone:317-664-0771
Mailing Address - Fax:
Practice Address - Street 1:3105 ROME CT SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4423
Practice Address - Country:US
Practice Address - Phone:317-664-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18-399363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical