Provider Demographics
NPI:1174904148
Name:DAVIS, JENNA SLAUGHTER (MD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:SLAUGHTER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 LAWRENCEVILLE HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2526
Mailing Address - Country:US
Mailing Address - Phone:248-240-0988
Mailing Address - Fax:
Practice Address - Street 1:2680 LAWRENCEVILLE HWY STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2526
Practice Address - Country:US
Practice Address - Phone:770-515-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301107553208000000X
GA80692208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice