Provider Demographics
NPI:1134417397
Name:DAVIS, SHIRLEY ANN (RN)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 FAIRINGTON RD
Mailing Address - Street 2:APT 17B
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1708
Mailing Address - Country:US
Mailing Address - Phone:678-908-2037
Mailing Address - Fax:
Practice Address - Street 1:5959 FAIRINGTON RD
Practice Address - Street 2:APT 17B
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-1708
Practice Address - Country:US
Practice Address - Phone:678-908-2037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN101602163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse