MEDICARE: OCTAVIA HARRIS-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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1740167089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OCTAVIA HARRIS-DAVIS

Provider Business Mailing Address
First Line	:	3607 MONTROSE DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-4613
Country	:	US
Telephone Number	:	845-573-8465
Fax Number	:	845-573-8465

Provider Business Practice Location Address
First Line	:	3100 GENTIAN BLVD # 8A
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-5670
Country	:	US
Telephone Number	:	706-530-8756
Fax Number	:

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

Provider Enumeration Date	:	08/19/2025
Last Update Date	:	08/19/2025

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Directions to “ OCTAVIA HARRIS-DAVIS ” Practice Location

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