Provider Demographics
NPI:1306254560
Name:DAVIS, EMILY (MED CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 BEMISS RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1934
Mailing Address - Country:US
Mailing Address - Phone:229-244-1667
Mailing Address - Fax:229-244-8253
Practice Address - Street 1:2301 BEMISS RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1934
Practice Address - Country:US
Practice Address - Phone:229-244-1667
Practice Address - Fax:229-244-8253
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist