Active NPI
Adrienne Cole Davis, PHD
- Forensic Psychologist
- Evans, GA
National Provider Identifier
1730247560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Psychologist
- License
- PSY9475
- Practice address
- 457 Columbia Industrial Blvd.
Suite 12
Evans, GA 30809-6691 - Phone
- (706) 922-3027
- Fax
- (706) 364-8996
- NPI assigned
- Dec 5, 2006
- Last updated
- Sep 14, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS-T000825 | GA | |
| Psychologist | 103T00000X | PSY003252 | GA | |
| Clinical Psychologist | 103TC0700X | PSY 9475 | CA | |
| Forensic Psychologist | 103TF0200X | PSY9475 | CA | Primary |
Addresses
Primary practice location
457 Columbia Industrial Blvd.
Suite 12
Evans, GA 30809-6691
Mailing address
457 Columbia Industrial Blvd.
Suite 12
Evans, GA 30809-6691
Phone (706) 922-3027
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 649764982A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS-T000825 | GA | MD | Psychologist |
| PSY 9475 | CA | MD | Clinical Psychologist |
| PSY9475 | CA | MD | Forensic Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284422400000",
"number": "1730247560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "457 COLUMBIA INDUSTRIAL BLVD.",
"address_2": "SUITE 12",
"city": "EVANS",
"state": "GA",
"postal_code": "308096691",
"telephone_number": "706-922-3027",
"fax_number": "706-364-8996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "457 COLUMBIA INDUSTRIAL BLVD.",
"address_2": "SUITE 12",
"city": "EVANS",
"state": "GA",
"postal_code": "308096691",
"telephone_number": "706-922-3027",
"fax_number": "706-364-8996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "ADRIENNE",
"middle_name": "COLE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-05",
"last_updated": "2010-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "PS-T000825",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "PSY003252",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 9475",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "CA",
"license": "PSY9475",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "649764982A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evans, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.