Healthcare Provider Details

I. General information

NPI: 1063308427
Provider Name (Legal Business Name): MAGGIE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2369 BEAM RD
COLUMBUS IN
47203-3404
US

IV. Provider business mailing address

2369 BEAM RD
COLUMBUS IN
47203-3404
US

V. Phone/Fax

Practice location:
  • Phone: 812-900-5463
  • Fax: 855-919-4295
Mailing address:
  • Phone: 812-900-5463
  • Fax: 855-919-4295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: