Healthcare Provider Details

I. General information

NPI: 1861988891
Provider Name (Legal Business Name): LINETTE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OBETZ RD
COLUMBUS OH
43207-4036
US

IV. Provider business mailing address

589 S JAMES RD
COLUMBUS OH
43213-2710
US

V. Phone/Fax

Practice location:
  • Phone: 614-409-1400
  • Fax:
Mailing address:
  • Phone: 614-377-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2102088-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: