Provider Demographics
NPI:1629651773
Name:DAVIS, ERIN MISHAY (MA ED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MISHAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ADRIAN DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3009
Mailing Address - Country:US
Mailing Address - Phone:678-326-8796
Mailing Address - Fax:
Practice Address - Street 1:103 ADRIAN DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3009
Practice Address - Country:US
Practice Address - Phone:678-326-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010929235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty