MEDICARE: DR. BETHANY B DAVIS M.D.

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	2084P0800X	Psychiatry Physician	51782	GA

General Provider Information

NPI Number	:	1881763001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETHANY B DAVIS M.D.

Provider Business Mailing Address
First Line	:	40 ANGUS TRL
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3030
Country	:	US
Telephone Number	:	704-223-0062
Fax Number	:

Provider Business Practice Location Address
First Line	:	6065 ROSWELL RD STE 820
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4018
Country	:	US
Telephone Number	:	470-223-0062
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	05/29/2024

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