Provider Demographics
NPI:1053475855
Name:DAVISON, JANELLE LYNETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:LYNETTE
Last Name:DAVISON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2450 ATLANTA RD SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2073
Mailing Address - Country:US
Mailing Address - Phone:770-428-0414
Mailing Address - Fax:770-428-0415
Practice Address - Street 1:2450 ATLANTA RD SE STE 200
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2073
Practice Address - Country:US
Practice Address - Phone:770-428-0414
Practice Address - Fax:770-428-0415
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist