Provider Demographics
NPI:1528113370
Name:DAVITT, JENNIFER LARUE (CRNFA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LARUE
Last Name:DAVITT
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:GA
Mailing Address - Zip Code:30557-3573
Mailing Address - Country:US
Mailing Address - Phone:706-244-1067
Mailing Address - Fax:888-874-3544
Practice Address - Street 1:709 WILSON RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:GA
Practice Address - Zip Code:30557-3573
Practice Address - Country:US
Practice Address - Phone:706-244-1067
Practice Address - Fax:888-874-3544
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN147341163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant