MEDICARE: MRS. VONNIA LYNETTE HARRIS-DAVIS CCC SLP

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	235Z00000X	Speech-Language Pathologist	003913	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	09140197	OTHER		NATIONAL ASHA AMERICAN SP

General Provider Information

NPI Number	:	1740267186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VONNIA LYNETTE HARRIS-DAVIS CCC SLP

Provider Business Mailing Address
First Line	:	3207 LOVELL DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311
Country	:	US
Telephone Number	:	404-349-8381
Fax Number	:

Provider Business Practice Location Address
First Line	:	3207 LOVELL DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311
Country	:	US
Telephone Number	:	404-349-8381
Fax Number	:

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	07/08/2007

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