Provider Demographics
NPI:1114218302
Name:DAVIS, JELANI GEMAR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JELANI
Middle Name:GEMAR
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MARGIE DR
Mailing Address - Street 2:APARTMENT #902
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-7600
Mailing Address - Country:US
Mailing Address - Phone:704-307-9596
Mailing Address - Fax:
Practice Address - Street 1:116 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6340
Practice Address - Country:US
Practice Address - Phone:478-275-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist