MEDICARE: MRS. DOINDA D DAVISON

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	172V00000X	Community Health Worker	7706969	OH

General Provider Information

NPI Number	:	1407083694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOINDA D DAVISON

Provider Business Mailing Address
First Line	:	576 PATTERSON AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-3358
Country	:	US
Telephone Number	:	330-285-9945
Fax Number	:	330-285-9945

Provider Business Practice Location Address
First Line	:	576 PATTERSON AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-3358
Country	:	US
Telephone Number	:	330-285-9945
Fax Number	:	330-285-9945

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

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	06/16/2009

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