Provider Demographics
NPI:1588832547
Name:DAVIS, LINDA L (MSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1993
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-0036
Mailing Address - Country:US
Mailing Address - Phone:706-878-0036
Mailing Address - Fax:
Practice Address - Street 1:966 RABUN RD.
Practice Address - Street 2:
Practice Address - City:SAUTEE-NACOOCHEE
Practice Address - State:GA
Practice Address - Zip Code:30571-9998
Practice Address - Country:US
Practice Address - Phone:706-878-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0006031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBBFXMedicare UPIN