Provider Demographics
NPI:1679058614
Name:DAVIS, ANGELA CHRISTINA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHRISTINA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:CHRISTINA
Other - Last Name:LEGGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:192 CAMDALE CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-2305
Mailing Address - Country:US
Mailing Address - Phone:478-777-0450
Mailing Address - Fax:
Practice Address - Street 1:657 HEMLOCK ST STE 220
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8311
Practice Address - Country:US
Practice Address - Phone:478-741-7241
Practice Address - Fax:478-745-8932
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11081363LA2100X
GARN185946363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty