Healthcare Provider Details

I. General information

NPI: 1356996136
Provider Name (Legal Business Name): THE DAVIDSON HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 04/11/2020
Certification Date: 04/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 MALLOY ST
LITTLE ROCK AR
72204-4480
US

IV. Provider business mailing address

3305 MALLOY ST
LITTLE ROCK AR
72204-4480
US

V. Phone/Fax

Practice location:
  • Phone: 501-412-5520
  • Fax:
Mailing address:
  • Phone: 501-412-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: SEAN LUKE DAVIDSON
Title or Position: CEO, MD
Credential:
Phone: 501-412-5520