Provider Demographics
NPI:1942347372
Name:DAVIS, TAMIKA A (NP)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:812 GRASSMEADE WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5694
Mailing Address - Country:US
Mailing Address - Phone:404-296-7133
Mailing Address - Fax:404-296-7211
Practice Address - Street 1:812 GRASSMEADE WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5694
Practice Address - Country:US
Practice Address - Phone:404-296-7133
Practice Address - Fax:404-296-7211
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA145041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA820705363Medicaid
GA820705363Medicaid