Provider Demographics
NPI:1033432414
Name:DAVISON, MICHAEL ELVIS (RN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ELVIS
Last Name:DAVISON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:ELVIS
Other - Last Name:DAVISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1900 EXETER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2954
Mailing Address - Country:US
Mailing Address - Phone:901-818-2160
Mailing Address - Fax:901-682-9522
Practice Address - Street 1:1900 EXETER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2954
Practice Address - Country:US
Practice Address - Phone:901-818-2160
Practice Address - Fax:901-682-9522
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR54101163W00000X
TNAPN 15003367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00907127OtherRAILROAD MEDICARE
TN4264006OtherBLUE CROSS
MS09304510Medicaid
TN1520341Medicaid
TN103I437284Medicare PIN