Healthcare Provider Details

I. General information

NPI: 1679679922
Provider Name (Legal Business Name): JAMES V DAVIDSON MA CCCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W FAULKNER
EL DORADO AR
71730
US

IV. Provider business mailing address

530 W FAULKNER
EL DORADO AR
71730
US

V. Phone/Fax

Practice location:
  • Phone: 870-862-5339
  • Fax: 870-862-7571
Mailing address:
  • Phone: 870-862-5339
  • Fax: 870-862-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number42
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number229
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: