1508410226 NPI number — PEYTON ELISE DAVIS MS, LAT, ATC

Table of content: PEYTON ELISE DAVIS MS, LAT, ATC (NPI 1508410226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508410226 NPI number — PEYTON ELISE DAVIS MS, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
PEYTON
Provider Middle Name:
ELISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508410226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1035 BARNETT SHOALS RD APT 810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30605-7325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-435-1605
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 FELD WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMETTO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34221-6514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-448-4196
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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