Basic Information
| Provider Information | |||||||||
| NPI: | 1841862505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | BEAU | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MSN, RN, AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4150 DEPUTY BILL CANTRELL MEMORIAL RD. | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708868111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4150 DEPUTY BILL CANTRELL MEMORIAL RD. | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708868111 | ||||||||
| FaxNumber: | 7702058539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2021 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | RN277433 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.