Provider Demographics
NPI:1033626056
Name:DAVIS, SYDNIE MYRELL
Entity Type:Individual
Prefix:
First Name:SYDNIE
Middle Name:MYRELL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 CAPRI CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-4315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:454 HIGHWAY 165
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:AL
Practice Address - Zip Code:36856-4303
Practice Address - Country:US
Practice Address - Phone:706-321-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst