Healthcare Provider Details

I. General information

NPI: 1043912553
Provider Name (Legal Business Name): SYMONE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 S CENTRAL AVE
COLUMBUS OH
43223-1301
US

IV. Provider business mailing address

1582 N WAGGONER RD
BLACKLICK OH
43004-8669
US

V. Phone/Fax

Practice location:
  • Phone: 614-274-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: