MEDICARE: SYDNIE MYRELL DAVIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		GA
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1033626056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNIE MYRELL DAVIS

Provider Business Mailing Address
First Line	:	6060 CAPRI CIR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-4315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	454 HIGHWAY 165
Second Line	:
City	:	FORT MITCHELL
State	:	AL
Zip	:	36856-4303
Country	:	US
Telephone Number	:	706-321-2288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2017
Last Update Date	:	06/16/2018

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