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NPI Code Detail

MEDICARE: ALTON G DAVIDSON M.D.

MEDICARE: ALTON G DAVIDSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204C00000XSports Medicine (Neuromusculoskeletal Medicine) Physician025503GA

General Provider Information

NPI Number : 1821083304
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALTON G DAVIDSON M.D.
Provider Business Mailing Address
First Line : 1046 RIDGE AVE SW
Second Line :
City : ATLANTA
State : GA
Zip : 30315-1640
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1046 RIDGE AVE SW
Second Line :
City : ATLANTA
State : GA
Zip : 30315-1640
Country : US
Telephone Number : 404-688-1350
Fax Number : 404-564-6734
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 07/08/2007

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