Davis, Deborah Wickham

Davis, Deborah Wickham is an individual health care provider with primary practice located at 1680 Hiram Douglasville Hwy , Hiram GA 30141-3739. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics, which is considered as her primary health care specialty. Davis, Deborah Wickham can be contacted via phone (770) 943-7979.

Contact Information

Primary practice address
1680 Hiram Douglasville Hwy Hiram GA 30141-3739
Phone: (770) 943-7979
Fax: (770) 943-7161
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics 2251P0200X PT005820 Georgia

Profile Details

NPI number 1740404979
LBN Legal business name Davis, Deborah Wickham
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 12th, 2007
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740404979 NPPES
Georgia MEDICAID 326066
Georgia Other 004973
Georgia MEDICAID 10052032
Georgia MEDICAID 00801292C

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