Healthcare Provider Details

I. General information

NPI: 1740240902
Provider Name (Legal Business Name): MICHAEL JAMES DAVIDSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 N ELLINGTON PKWY SUITE 102
LEWISBURG TN
37091-2227
US

IV. Provider business mailing address

854 W JAMES CAMPBELL BLVD SUITE 303
COLUMBIA TN
38401-4659
US

V. Phone/Fax

Practice location:
  • Phone: 913-359-0019
  • Fax: 931-359-7381
Mailing address:
  • Phone: 931-359-0019
  • Fax: 931-359-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO781
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: