Healthcare Provider Details

I. General information

NPI: 1164908653
Provider Name (Legal Business Name): CHRISTINA JO DAVISON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 BRAEBURN DR
SALEM VA
24153-7302
US

IV. Provider business mailing address

2552 ORANGE AVE NE APT 305
ROANOKE VA
24012-6275
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-0253
  • Fax:
Mailing address:
  • Phone: 307-679-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301355
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: