MEDICARE: EVONDA 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1245949726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVONDA DAVIS

Provider Business Mailing Address
First Line	:	1671 RIVERCHASE CIRCLE EAST NE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-1199
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5461 HILLANDALE DR
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-4841
Country	:	US
Telephone Number	:	470-361-2976
Fax Number	:

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

Provider Enumeration Date	:	11/23/2022
Last Update Date	:	11/23/2022

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Directions to “ EVONDA DAVIS ” Practice Location

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