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NPI Code Detail

MEDICARE: DR. BRENT WILLIAM DAVIDSON MD

MEDICARE: DR. BRENT WILLIAM DAVIDSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician029622GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104874197
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRENT WILLIAM DAVIDSON MD
Provider Business Mailing Address
First Line : PO BOX 509
Second Line :
City : HIAWASSEE
State : GA
Zip : 30546-0509
Country : US
Telephone Number : 706-896-2222
Fax Number : 706-896-7872
Provider Business Practice Location Address
First Line : 110 S MAIN ST
Second Line :
City : HIAWASSEE
State : GA
Zip : 30546-3408
Country : US
Telephone Number : 706-896-2222
Fax Number : 706-896-7872
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 01/05/2010

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Directions to “ DR. BRENT WILLIAM DAVIDSON MD” Practice Location

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