Provider Demographics
NPI:1720863475
Name:DAVIS-HENDERSON, G'MECIAH
Entity Type:Individual
Prefix:
First Name:G'MECIAH
Middle Name:
Last Name:DAVIS-HENDERSON
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 1:1323 S GREENSTONE LN
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2832
Mailing Address - Country:US
Mailing Address - Phone:817-986-8557
Mailing Address - Fax:
Practice Address - Street 1:1111 W MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5028
Practice Address - Country:US
Practice Address - Phone:972-489-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator