Provider Demographics
NPI:1497306781
Name:DAVIS, TERRY JOE (FNP)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:JOE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 CROTWELL RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4192
Mailing Address - Country:US
Mailing Address - Phone:229-886-8340
Mailing Address - Fax:
Practice Address - Street 1:2300 DAWSON RD STE 101
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2804
Practice Address - Country:US
Practice Address - Phone:229-436-8535
Practice Address - Fax:229-436-0363
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN162541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily