Provider Demographics
NPI:1336786979
Name:DAVIS, DHYLLES
Entity Type:Individual
Prefix:
First Name:DHYLLES
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COASTAL PL APT 7
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-5535
Mailing Address - Country:US
Mailing Address - Phone:347-863-8813
Mailing Address - Fax:
Practice Address - Street 1:104 E 40TH ST STE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-9119
Practice Address - Country:US
Practice Address - Phone:347-863-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA83-4632387OtherOUT OF POCKET PAYMENTS