Provider Demographics
NPI:1063843480
Name:DAVIS, BOBBIE DAVONNA
Entity Type:Individual
Prefix:MISS
First Name:BOBBIE
Middle Name:DAVONNA
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 1:312 MADISON AVE N
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-4612
Mailing Address - Country:US
Mailing Address - Phone:912-384-4357
Mailing Address - Fax:
Practice Address - Street 1:312 MADISON AVE N
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-4612
Practice Address - Country:US
Practice Address - Phone:912-850-4759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst