Provider Demographics
NPI:1457146292
Name:DAVIS, LASANDRA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LASANDRA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:MEIGS
Mailing Address - State:GA
Mailing Address - Zip Code:31765
Mailing Address - Country:US
Mailing Address - Phone:229-712-5706
Mailing Address - Fax:
Practice Address - Street 1:150 YELLOW PINE LN
Practice Address - Street 2:
Practice Address - City:OCHLOCKNEE
Practice Address - State:GA
Practice Address - Zip Code:31773-2283
Practice Address - Country:US
Practice Address - Phone:229-712-5706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy