Provider Demographics
NPI:1255030466
Name:DAVIS, ARDEINA M (BS, CPS, PP)
Entity type:Individual
Prefix:
First Name:ARDEINA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BS, CPS, PP
Other - Prefix:
Other - First Name:ARDEINA
Other - Middle Name:M
Other - Last Name:MCPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2257 ASQUITH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-6092
Mailing Address - Country:US
Mailing Address - Phone:912-308-1323
Mailing Address - Fax:
Practice Address - Street 1:3780 W COUNTY LINE RD STE C
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1164
Practice Address - Country:US
Practice Address - Phone:770-693-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist