Provider Demographics
NPI:1811194723
Name:DAVIDSON, MARY GAGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:GAGE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6140 LENOX PARK CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-5365
Mailing Address - Country:US
Mailing Address - Phone:404-935-8385
Mailing Address - Fax:404-874-2020
Practice Address - Street 1:1904 MONROE DR NE
Practice Address - Street 2:STE. 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4858
Practice Address - Country:US
Practice Address - Phone:404-935-8385
Practice Address - Fax:404-874-2020
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2036103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist