Provider Demographics
NPI:1700879244
Name:DAVIS, ELEANOR SHARON (CNM)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:SHARON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 MEREDYTH DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2267
Mailing Address - Country:US
Mailing Address - Phone:229-883-7010
Mailing Address - Fax:229-430-9220
Practice Address - Street 1:2701 MEREDYTH DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2267
Practice Address - Country:US
Practice Address - Phone:229-883-7010
Practice Address - Fax:229-430-9220
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
GAR076668367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA618956236AMedicaid
S84565Medicare UPIN