Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3652 | GA |
Y | 103TC0700X | Clinical Psychologist | 3652 | GA |
N | 103TC1900X | Counseling Psychologist | 3652 | GA |
NPI | 1013352988 |
---|---|
Provider Name | Dr. Telsie A. Davis |
First Address | Atlanta, GA 30303-3031 |
Second Address | Atlanta, GA 30303-3031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2013 |
Last Update Date | 06/05/2013 |