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NPI Code Detail

MEDICARE: DR. EDGAR DAVIS PH.D.

MEDICARE: DR. EDGAR DAVIS PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist20041255AIN
2103TH0100XHealth Service Psychologist20041255AIN

General Provider Information

NPI Number : 1124157995
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDGAR DAVIS PH.D.
Provider Business Mailing Address
First Line : 4401 CENTRAL AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46205-1822
Country : US
Telephone Number : 317-923-2333
Fax Number : 317-923-2367
Provider Business Practice Location Address
First Line : 4401 CENTRAL AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46205-1822
Country : US
Telephone Number : 317-923-2333
Fax Number : 317-923-2367
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 12/07/2025

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