Provider Demographics
NPI:1669631800
Name:DAVISON, WENDY N (CPNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:N
Last Name:DAVISON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:N
Other - Last Name:HECKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 FRANKLIN RD SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8705
Mailing Address - Country:US
Mailing Address - Phone:770-951-5400
Mailing Address - Fax:678-388-1399
Practice Address - Street 1:1405 FRANKLIN RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8705
Practice Address - Country:US
Practice Address - Phone:770-951-5400
Practice Address - Fax:678-388-1399
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN140026363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA382184721AMedicaid