Provider Demographics
NPI:1174276299
Name:DAVIS-GULLEY, NIKKITA
Entity Type:Individual
Prefix:
First Name:NIKKITA
Middle Name:
Last Name:DAVIS-GULLEY
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 1:2131 KINGSTON CT SE STE 100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8929
Mailing Address - Country:US
Mailing Address - Phone:470-303-3803
Mailing Address - Fax:
Practice Address - Street 1:2131 KINGSTON CT SE STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8929
Practice Address - Country:US
Practice Address - Phone:470-303-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date: