Provider Demographics
NPI:1740267186
Name:HARRIS-DAVIS, VONNIA LYNETTE (CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:VONNIA
Middle Name:LYNETTE
Last Name:HARRIS-DAVIS
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 LOVELL DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311
Mailing Address - Country:US
Mailing Address - Phone:404-349-8381
Mailing Address - Fax:
Practice Address - Street 1:3207 LOVELL DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311
Practice Address - Country:US
Practice Address - Phone:404-349-8381
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00742277EMedicaid
09140197OtherNATIONAL ASHA AMERICAN SP