MEDICARE: DR. HARRISON DAVIS JR. LPC, PH.D

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	101YM0800X	Mental Health Counselor	3243	GA
2	101YP2500X	Professional Counselor	3243	GA

General Provider Information

NPI Number	:	1679587836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRISON DAVIS JR. LPC, PH.D

Provider Business Mailing Address
First Line	:	1000 JEFFERSON ST.
Second Line	:	STE. 2C
City	:	LYNCHBURG
State	:	VA
Zip	:	24504
Country	:	US
Telephone Number	:	617-375-0496
Fax Number	:	617-807-0958

Provider Business Practice Location Address
First Line	:	8800 ROSWELL RD.
Second Line	:	STE. A135
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350
Country	:	US
Telephone Number	:	404-682-1923
Fax Number	:	678-579-9664

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/24/2015

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