Provider Demographics
NPI:1114112257
Name:DAVIS, KIMBERLY NYOTA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:NYOTA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3459 JOHNSON FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5206
Mailing Address - Country:US
Mailing Address - Phone:678-524-0992
Mailing Address - Fax:
Practice Address - Street 1:3459 JOHNSON FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5206
Practice Address - Country:US
Practice Address - Phone:678-524-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional