MEDICARE: ASHLI DAVIS LMT

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	MT013476	GA

General Provider Information

NPI Number	:	1083363857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLI DAVIS LMT

Provider Business Mailing Address
First Line	:	220 SANDY SPRINGS CIR STE 157B
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-3861
Country	:	US
Telephone Number	:	404-295-7040
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 SANDY SPRINGS CIR STE 157B
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-3861
Country	:	US
Telephone Number	:	404-295-7040
Fax Number	:

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

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	03/21/2022

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Directions to “ ASHLI DAVIS LMT” Practice Location

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