Provider Demographics
NPI:1457052706
Name:DAVIS, DANA LEA
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:LEA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 ELLERY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2543
Mailing Address - Country:US
Mailing Address - Phone:614-756-7856
Mailing Address - Fax:
Practice Address - Street 1:4747 ELLERY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2543
Practice Address - Country:US
Practice Address - Phone:614-756-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH92-2867635Medicaid