Healthcare Provider Details

I. General information

NPI: 1114924925
Provider Name (Legal Business Name): PAUL C DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW SUITE 450
ATLANTA GA
30318-2538
US

IV. Provider business mailing address

1800 HOWELL MILL RD NW SUITE 450
ATLANTA GA
30318-2538
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-4393
  • Fax: 770-258-5103
Mailing address:
  • Phone: 404-355-4395
  • Fax: 770-258-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number019505
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: