MEDICARE: MYASIA 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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1255929030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYASIA DAVIS

Provider Business Mailing Address
First Line	:	35 N VALLEY ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44303-2013
Country	:	US
Telephone Number	:	234-706-0076
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 N VALLEY ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44303-2013
Country	:	US
Telephone Number	:	234-706-0076
Fax Number	:

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

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/06/2021

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Directions to “ MYASIA DAVIS ” Practice Location

Language	Start Address	Practice Location

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