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NPI Code Detail

MEDICARE: ANGELA DAVIS

MEDICARE: ANGELA 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
1106S00000XBehavior TechnicianGA

General Provider Information

NPI Number : 1639018211
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA DAVIS
Provider Business Mailing Address
First Line : 822 TOPAZ VLY
Second Line :
City : CANTON
State : GA
Zip : 30114-8314
Country : US
Telephone Number : 678-602-8547
Fax Number :
Provider Business Practice Location Address
First Line : 260 PEACHTREE ST NW STE 2200
Second Line :
City : ATLANTA
State : GA
Zip : 30303-1292
Country : US
Telephone Number : 877-418-2978
Fax Number : 866-500-2186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2026
Last Update Date : 03/27/2026

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