Provider Demographics
NPI:1174192074
Name:DAVIS, NATHANIEL JEFFERY
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:JEFFERY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 FRANCES MEEKS WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3984
Mailing Address - Country:US
Mailing Address - Phone:912-445-2098
Mailing Address - Fax:
Practice Address - Street 1:128 FRANCES MEEKS WAY STE 5
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3984
Practice Address - Country:US
Practice Address - Phone:912-445-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst