Provider Demographics
NPI:1730247560
Name:DAVIS, ADRIENNE COLE (PHD)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:COLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 COLUMBIA INDUSTRIAL BLVD.
Mailing Address - Street 2:SUITE 12
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-6691
Mailing Address - Country:US
Mailing Address - Phone:706-922-3027
Mailing Address - Fax:706-364-8996
Practice Address - Street 1:457 COLUMBIA INDUSTRIAL BLVD.
Practice Address - Street 2:SUITE 12
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-6691
Practice Address - Country:US
Practice Address - Phone:706-922-3027
Practice Address - Fax:706-364-8996
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9475103TF0200X
CAPSY 9475103TC0700X
GAPS-T000825103T00000X
GAPSY003252103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA649764982AMedicaid