Provider Demographics
NPI:1568779601
Name:DAVIS, JENNIFER LYNN
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DAVIS
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 1:1502 HUBERT PITTMAN RD
Mailing Address - Street 2:
Mailing Address - City:PENDERGRASS
Mailing Address - State:GA
Mailing Address - Zip Code:30567-2907
Mailing Address - Country:US
Mailing Address - Phone:706-693-2650
Mailing Address - Fax:
Practice Address - Street 1:1502 HUBERT PITTMAN RD
Practice Address - Street 2:
Practice Address - City:PENDERGRASS
Practice Address - State:GA
Practice Address - Zip Code:30567-2907
Practice Address - Country:US
Practice Address - Phone:706-693-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical