MEDICARE: DR. PAUL C 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
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	019505	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110008960	OTHER	GA	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1114924925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL C DAVIDSON MD

Provider Business Mailing Address
First Line	:	1800 HOWELL MILL RD NW
Second Line	:	SUITE 450
City	:	ATLANTA
State	:	GA
Zip	:	30318-2538
Country	:	US
Telephone Number	:	404-355-4395
Fax Number	:	770-258-5103

Provider Business Practice Location Address
First Line	:	1800 HOWELL MILL RD NW
Second Line	:	SUITE 450
City	:	ATLANTA
State	:	GA
Zip	:	30318-2538
Country	:	US
Telephone Number	:	404-355-4393
Fax Number	:	770-258-5103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/27/2016

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