Provider Demographics
NPI:1508457201
Name:DAVIS, CHELSEA (CLC, CLD (DV))
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CLC, CLD (DV)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3790 WESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-7664
Mailing Address - Country:US
Mailing Address - Phone:470-848-4006
Mailing Address - Fax:
Practice Address - Street 1:3790 WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-7664
Practice Address - Country:US
Practice Address - Phone:470-848-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
GA329052174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula