Provider Demographics
NPI:1063831345
Name:DAVIS, GEORGE ELGIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ELGIN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 6TH ST
Mailing Address - Street 2:212
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-1328
Mailing Address - Country:US
Mailing Address - Phone:562-243-6320
Mailing Address - Fax:
Practice Address - Street 1:110 W 6TH ST
Practice Address - Street 2:212
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-1328
Practice Address - Country:US
Practice Address - Phone:562-243-6320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic