MEDICARE: NICOSIA DAVIS LMSW

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	104100000X	Social Worker	4288G	AL

General Provider Information

NPI Number	:	1891206462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOSIA DAVIS LMSW

Provider Business Mailing Address
First Line	:	20 HUGHES RD STE 101
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-2434
Country	:	US
Telephone Number	:	256-325-1556
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 HUGHES RD STE 101
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-2434
Country	:	US
Telephone Number	:	256-325-1556
Fax Number	:

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

Provider Enumeration Date	:	10/23/2017
Last Update Date	:	10/23/2017

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Directions to “ NICOSIA DAVIS LMSW” Practice Location

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