Individual
DEBORAH WICKHAM DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1680 HIRAM DOUGLASVILLE HWY, HIRAM, GA 30141-3739
(770) 943-7979
(770) 943-7161
Mailing address
PO BOX 921, HIRAM, GA 30141-0921
(770) 943-7979
(770) 943-7161
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT005820
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004973
BLUE CROSS BLUE SHIELD
GA
05
—
00801292C
—
GA
05
—
10052032
—
GA
05
—
326066
—
GA
Enumeration date
04/12/2007
Last updated
07/09/2007
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