Provider Demographics
NPI:1932710159
Name:DAVIS, KAREN JOHNSON (PFC, PIC, HC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:JOHNSON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PFC, PIC, HC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 MICAH CT
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-6224
Mailing Address - Country:US
Mailing Address - Phone:404-314-4737
Mailing Address - Fax:404-891-8992
Practice Address - Street 1:3719 MICAH CT
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-6224
Practice Address - Country:US
Practice Address - Phone:404-314-4737
Practice Address - Fax:404-891-8992
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X, 171M00000X, 172V00000X, 174400000X, 1744R1103X, 174N00000X, 175F00000X, 246Y00000X, 332900000X, 332BC3200X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/CoderGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment