Provider Demographics
NPI:1982060802
Name:DAVIS, PRESTON SCOTT II (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:SCOTT
Last Name:DAVIS
Suffix:II
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8366 ROSWELL RD APT F
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-6412
Mailing Address - Country:US
Mailing Address - Phone:404-449-7110
Mailing Address - Fax:
Practice Address - Street 1:8366 ROSWELL RD APT F
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-6412
Practice Address - Country:US
Practice Address - Phone:404-449-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily