Provider Demographics
NPI:1861047953
Name:DAVIS, SHONTAE DEVONNE (PT)
Entity type:Individual
Prefix:MRS
First Name:SHONTAE
Middle Name:DEVONNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 ASHFORD CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-2673
Mailing Address - Country:US
Mailing Address - Phone:918-430-6181
Mailing Address - Fax:
Practice Address - Street 1:1240 ASHFORD CENTER PKWY
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-2673
Practice Address - Country:US
Practice Address - Phone:918-430-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist