Basic Information
| Provider Information | |||||||||
| NPI: | 1730802950 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | LEA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100925 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303840925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017717771 | ||||||||
| FaxNumber: | 8336432775 | ||||||||
| Practice Location | |||||||||
| Address1: | 217 N 2000 W | ||||||||
| Address2: | |||||||||
| City: | WEST POINT | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840158026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014758600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2022 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5184594-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.