Provider Demographics
NPI:1528475662
Name:DAVIS, ERIKA RENEE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:RENEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1739 BROOKSTONE LN NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4560
Mailing Address - Country:US
Mailing Address - Phone:484-643-2169
Mailing Address - Fax:
Practice Address - Street 1:1171 WHITLOCK AVE SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1932
Practice Address - Country:US
Practice Address - Phone:484-643-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0033342255A2300X
PARTO0001812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000013683OtherNATABOC