Provider Demographics
NPI:1083724017
Name:DAVIDSON, EVELYNE MONIQUE (MD)
Entity Type:Individual
Prefix:
First Name:EVELYNE
Middle Name:MONIQUE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 HOLSTON HILLS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-5007
Mailing Address - Country:US
Mailing Address - Phone:865-523-8987
Mailing Address - Fax:865-637-1835
Practice Address - Street 1:4611 HOLSTON HILLS RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-5007
Practice Address - Country:US
Practice Address - Phone:865-523-8987
Practice Address - Fax:865-637-1835
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN020655207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100022381OtherPHP TNCARE
TN3704598Medicaid
TN110221350OtherRAILROAD MEDICARE
TN3051987Medicaid
TN30519801Medicaid
TN4007807OtherBLUE CROSS
TN602002790OtherCARITEN
TN3051987Medicaid
TN1370041Medicare PIN
TN4007807OtherBLUE CROSS
E43133Medicare UPIN
TN3051987Medicare ID - Type Unspecified
TN30519801Medicaid