MEDICARE: KATHERINE 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1821535196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE DAVIS

Provider Business Mailing Address
First Line	:	124 BLUE RIDGE LN
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-7710
Country	:	US
Telephone Number	:	478-918-4288
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 BLUE RIDGE LN
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-7710
Country	:	US
Telephone Number	:	478-918-4288
Fax Number	:

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

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	01/25/2017

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Directions to “ KATHERINE DAVIS ” Practice Location

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