Provider Demographics
NPI:1265910475
Name:DAVIS, CARLY LOUDERBACK (FNP-C)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:LOUDERBACK
Last Name:DAVIS
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:MEGAN
Other - Last Name:LOUDERBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2724
Mailing Address - Country:US
Mailing Address - Phone:423-715-0867
Mailing Address - Fax:
Practice Address - Street 1:210 GILBERT RD
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2724
Practice Address - Country:US
Practice Address - Phone:423-715-0867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN277403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily