Provider Demographics
NPI:1205836277
Name:DAVIDSON, JAMES LEWIS (PH D)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEWIS
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5190 BAYOU BLVD
Mailing Address - Street 2:BLDG 6
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2194
Mailing Address - Country:US
Mailing Address - Phone:850-476-0977
Mailing Address - Fax:850-476-2558
Practice Address - Street 1:5190 BAYOU BLVD
Practice Address - Street 2:BLDG 6
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2194
Practice Address - Country:US
Practice Address - Phone:850-476-0977
Practice Address - Fax:850-476-2558
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2711103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74388Medicare ID - Type Unspecified