Provider Demographics
NPI:1184959801
Name:DAVIS, MENDY DEANDRA (DC)
Entity type:Individual
Prefix:DR
First Name:MENDY
Middle Name:DEANDRA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6175 OLD NATIONAL HWY STE 430
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-4470
Mailing Address - Country:US
Mailing Address - Phone:678-519-3472
Mailing Address - Fax:678-519-3579
Practice Address - Street 1:6175 OLD NATIONAL HWY STE 430
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-4470
Practice Address - Country:US
Practice Address - Phone:678-519-3472
Practice Address - Fax:678-519-3579
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor