MEDICARE: DR. DIANA DAVIDSON 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	103T00000X	Psychologist	PY6623	FL

General Provider Information

NPI Number	:	1679993513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA DAVIDSON PH.D.

Provider Business Mailing Address
First Line	:	1774 SMYRNA RD SW
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-6159
Country	:	US
Telephone Number	:	305-297-9717
Fax Number	:

Provider Business Practice Location Address
First Line	:	4781 N CONGRESS AVE # 2233
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7941
Country	:	US
Telephone Number	:	561-666-7256
Fax Number	:

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

Provider Enumeration Date	:	04/18/2014
Last Update Date	:	12/22/2025

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