MEDICARE: MR. ZAIDE ANDRE DAVIS LCSW

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	1041C0700X	Clinical Social Worker	C002871	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598743338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ZAIDE ANDRE DAVIS LCSW

Provider Business Mailing Address
First Line	:	1914 J N PEASE PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4504
Country	:	US
Telephone Number	:	704-287-0032
Fax Number	:	704-947-9785

Provider Business Practice Location Address
First Line	:	1914 J N PEASE PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4504
Country	:	US
Telephone Number	:	704-287-0032
Fax Number	:	704-947-9785

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	04/18/2013

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