Provider Demographics
NPI:1396346169
Name:DAVIS, DEBRA (LMT)
Entity type:Individual
Prefix:MISS
First Name:DEBRA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:207 CHESTNUT STR
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:GA
Mailing Address - Zip Code:39836
Mailing Address - Country:US
Mailing Address - Phone:229-310-0862
Mailing Address - Fax:
Practice Address - Street 1:702 BALDWIN DR STE A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-4027
Practice Address - Country:US
Practice Address - Phone:229-310-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT011126225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist