Provider Demographics
NPI:1720156110
Name:DAVIS, LAURA LEE (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 NECK RD
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4113
Mailing Address - Country:US
Mailing Address - Phone:678-267-4758
Mailing Address - Fax:770-953-0031
Practice Address - Street 1:1640 POWERS FERRY ROAD
Practice Address - Street 2:SUITE 100, BUILDING 9
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:770-953-0080
Practice Address - Fax:770-953-0031
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric