Healthcare Provider Details

I. General information

NPI: 1982920229
Provider Name (Legal Business Name): CHERYL FAITH DAVIDSON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 SEMINOLE AVE NE SUITE T05
ATLANTA GA
30307-3408
US

IV. Provider business mailing address

675 SEMINOLE AVE NE SUITE T05
ATLANTA GA
30307-3408
US

V. Phone/Fax

Practice location:
  • Phone: 404-575-4000
  • Fax: 404-575-4010
Mailing address:
  • Phone: 404-575-4000
  • Fax: 404-575-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT004070
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: