MEDICARE: SONYA DAVIS

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1215474705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONYA DAVIS

Provider Business Mailing Address
First Line	:	1004 N 4360 RD
Second Line	:
City	:	FORT TOWSON
State	:	OK
Zip	:	74735-1015
Country	:	US
Telephone Number	:	580-317-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 N 4360 RD
Second Line	:
City	:	FORT TOWSON
State	:	OK
Zip	:	74735-1015
Country	:	US
Telephone Number	:	580-317-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	01/23/2017

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Directions to “ SONYA DAVIS ” Practice Location

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