Provider Demographics
NPI:1386233781
Name:DAVIS, CHERMIKA SHANTE
Entity type:Individual
Prefix:
First Name:CHERMIKA
Middle Name:SHANTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 IVEY DR SW
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-3667
Mailing Address - Country:US
Mailing Address - Phone:478-251-4342
Mailing Address - Fax:
Practice Address - Street 1:134 IVEY DR SW
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-3667
Practice Address - Country:US
Practice Address - Phone:478-251-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACPB3556172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver