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General NPI Number Information
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NPI Number | 1447605498
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Entity Type | Individual
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Provider Name | NATHAN CARL DAVIDSON MD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 7601 SOUTHCREST PKWY
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4739
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Country | US
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Telephone | 662-772-2980
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Fax | 662-772-2960
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Provider Business Mailing Address
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Address Line | 965 RIDGE LAKE BLVD STE 315
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City | MEMPHIS
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State | TN
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Zip | 38120-9401
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Country | US
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Telephone | 877-348-1281
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Fax | 901-227-3206
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-13902
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 61501
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 28000
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License Number State | MS
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