Provider Demographics
NPI:1639535925
Name:DAVIS-IVERY, LASHELLE (ATC)
Entity Type:Individual
Prefix:
First Name:LASHELLE
Middle Name:
Last Name:DAVIS-IVERY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 SAINT MARYS RD
Mailing Address - Street 2:APT G13
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-6566
Mailing Address - Country:US
Mailing Address - Phone:330-338-6714
Mailing Address - Fax:
Practice Address - Street 1:301 WIRE RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-5419
Practice Address - Country:US
Practice Address - Phone:330-338-6714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0028442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer