Provider Demographics
NPI:1376882191
Name:DAVIS, JAMIL EMAN (PMHNP)
Entity Type:Individual
Prefix:
First Name:JAMIL
Middle Name:EMAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7574 HIGHWAY 85
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-3447
Mailing Address - Country:US
Mailing Address - Phone:229-395-8243
Mailing Address - Fax:770-284-6612
Practice Address - Street 1:7574 HIGHWAY 85
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-3447
Practice Address - Country:US
Practice Address - Phone:770-217-5168
Practice Address - Fax:770-284-6612
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA188113363LF0000X
GARN188113363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily