MEDICARE: KATHY DAVIS H.I.S.

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	237700000X	Hearing Instrument Specialist	HADS000781	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	582103530	OTHER	GA	HMO/PPO

General Provider Information

NPI Number	:	1598218687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY DAVIS H.I.S.

Provider Business Mailing Address
First Line	:	2114 HENDERSON MILL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-3762
Country	:	US
Telephone Number	:	770-934-4327
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 HENDERSON MILL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-3762
Country	:	US
Telephone Number	:	770-934-4327
Fax Number	:

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

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	07/26/2016

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