Provider Demographics
NPI:1619314754
Name:DAVIS, WILLIAM GARRETT
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GARRETT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-2812
Mailing Address - Country:US
Mailing Address - Phone:631-205-0762
Mailing Address - Fax:
Practice Address - Street 1:980 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-2812
Practice Address - Country:US
Practice Address - Phone:631-205-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000788106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist