Provider Demographics
NPI:1053478651
Name:CARSON, JOHN DAVIDSON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVIDSON
Last Name:CARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 EXCHANGE ST STE B7
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7646
Mailing Address - Country:US
Mailing Address - Phone:912-756-2273
Mailing Address - Fax:972-756-3773
Practice Address - Street 1:318 MALL BLVD STE 300B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4758
Practice Address - Country:US
Practice Address - Phone:912-358-1515
Practice Address - Fax:912-480-0505
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0163212083X0100X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD45013Medicare UPIN