Provider Demographics
NPI:1720376817
Name:DAVIS, DONOVAN DENNIS
Entity Type:Individual
Prefix:
First Name:DONOVAN
Middle Name:DENNIS
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 1:3817 WHITE HERON DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-2605
Mailing Address - Country:US
Mailing Address - Phone:407-448-3665
Mailing Address - Fax:
Practice Address - Street 1:3817 WHITE HERON DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-2605
Practice Address - Country:US
Practice Address - Phone:407-448-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker