MEDICARE: DR. ANDY 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	207Q00000X	Family Medicine Physician	C6213	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	13297000000	OTHER	AR	QUALCHOICE

General Provider Information

NPI Number	:	1396731550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDY DAVIDSON MD

Provider Business Mailing Address
First Line	:	16 HOSPITAL CIR STE A
Second Line	:
City	:	BATESVILLE
State	:	AR
Zip	:	72501-7343
Country	:	US
Telephone Number	:	870-262-5545
Fax Number	:	870-262-3253

Provider Business Practice Location Address
First Line	:	301 S MAIN ST
Second Line	:
City	:	CAVE CITY
State	:	AR
Zip	:	72521
Country	:	US
Telephone Number	:	870-283-5353
Fax Number	:	870-283-5988

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	06/15/2018

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