Provider Demographics
NPI:1104127208
Name:DAVIS, ADRIENNE CLARICE (MSW)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:CLARICE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5264 GOOSE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:GA
Mailing Address - Zip Code:39842-4496
Mailing Address - Country:US
Mailing Address - Phone:229-698-3971
Mailing Address - Fax:
Practice Address - Street 1:5264 GOOSE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:GA
Practice Address - Zip Code:39842-4496
Practice Address - Country:US
Practice Address - Phone:229-698-3971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker