Healthcare Provider Details

I. General information

NPI: 1811958812
Provider Name (Legal Business Name): DAVIDSON FAMILY MEDICINE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 KNOX COURT SUITE 100
DAVIDSON NC
28036-4329
US

IV. Provider business mailing address

PO BOX 4329
DAVIDSON NC
28036-4329
US

V. Phone/Fax

Practice location:
  • Phone: 704-892-5454
  • Fax: 704-892-5858
Mailing address:
  • Phone: 704-892-5454
  • Fax: 704-892-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. VONE MCDANIEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 704-892-5454