Provider Demographics
NPI:1962726687
Name:DAVIS, JACQUELINE WILLIAMS (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:WILLIAMS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 TIMBERBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6763
Mailing Address - Country:US
Mailing Address - Phone:229-259-9691
Mailing Address - Fax:
Practice Address - Street 1:200 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31698
Practice Address - Country:US
Practice Address - Phone:229-219-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0175081835P0018X
FLPS278411835P0018X
AL146781835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist