Healthcare Provider Details

I. General information

NPI: 1962503060
Provider Name (Legal Business Name): AMY T DAVIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 DAWSONVILLE HWY SUITE 2201
GAINESVILLE GA
30501-2610
US

IV. Provider business mailing address

629 DAWSONVILLE HWY SUITE 2201
GAINESVILLE GA
30501-2610
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-9100
  • Fax: 770-534-9104
Mailing address:
  • Phone: 770-534-9100
  • Fax: 770-534-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1575
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1575
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1575
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: