Provider Demographics
NPI:1104841477
Name:DAVIDSON, OLIVER (CRNA)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 N BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-5945
Mailing Address - Country:US
Mailing Address - Phone:256-351-0775
Mailing Address - Fax:256-351-0775
Practice Address - Street 1:1716 EVA RD NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-6006
Practice Address - Country:US
Practice Address - Phone:800-277-8151
Practice Address - Fax:336-841-6217
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-020760367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered