Provider Demographics
NPI:1366859225
Name:DAVIS, BETTY
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
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 1:3409 VISIONARY BAY AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6514
Mailing Address - Country:US
Mailing Address - Phone:404-538-3476
Mailing Address - Fax:404-478-8035
Practice Address - Street 1:3409 VISIONARY BAY AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6514
Practice Address - Country:US
Practice Address - Phone:404-538-3476
Practice Address - Fax:404-478-8035
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator