Provider Demographics
NPI:1184820128
Name:DAVIS, SHERRY ANNICE (NP-C)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANNICE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:ANNICE
Other - Last Name:HARWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-297-5700
Practice Address - Fax:770-718-1877
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN050862363LF0000X, 163WX0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA315377424CMedicaid
GA315377424EOtherPEACH STATE
GA1202662OtherWELLCARE
GA03774175OtherAMERIGROUP
GA315377424DMedicaid
GA315377424FOtherPEACH STATE
GA050862OtherGNL
GA315377424COtherPEACH STATE
GA315377424DOtherPEACH STATE
GA315377424FMedicaid
GA315377424EMedicaid
GA315377424FMedicaid