Provider Demographics
NPI:1609406784
Name:DAVIS, DORIS ANN LYNETTE (APRN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:ANN LYNETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MORGAN PINES DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-3618
Mailing Address - Country:US
Mailing Address - Phone:912-228-6535
Mailing Address - Fax:
Practice Address - Street 1:6602 ABERCORN ST STE 102
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5849
Practice Address - Country:US
Practice Address - Phone:912-352-7546
Practice Address - Fax:877-662-6728
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21864363L00000X, 363LP2300X
GA227372363LA2200X, 363LG0600X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care