Healthcare Provider Details

I. General information

NPI: 1427171149
Provider Name (Legal Business Name): GWEN YVONNE DAVIES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 RALPH MCGILL BLVD NE
ATLANTA GA
30308-3339
US

IV. Provider business mailing address

704 DANCING FOX RD
DECATUR GA
30032-3978
US

V. Phone/Fax

Practice location:
  • Phone: 404-589-9040
  • Fax: 404-589-1615
Mailing address:
  • Phone: 404-589-9040
  • Fax: 404-589-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2722
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: