Provider Demographics
NPI:1639300601
Name:DAVIS, LISHA BUTLER (PA)
Entity Type:Individual
Prefix:DR
First Name:LISHA
Middle Name:BUTLER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 N DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5910
Mailing Address - Country:US
Mailing Address - Phone:404-659-5909
Mailing Address - Fax:770-399-9449
Practice Address - Street 1:2712 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5910
Practice Address - Country:US
Practice Address - Phone:404-659-5909
Practice Address - Fax:770-399-9449
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1883363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant