Provider Demographics
NPI:1437331832
Name:GOLSON, DAVIS (PAC)
Entity Type:Individual
Prefix:
First Name:DAVIS
Middle Name:
Last Name:GOLSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2534
Mailing Address - Country:US
Mailing Address - Phone:510-644-0200
Mailing Address - Fax:510-644-2044
Practice Address - Street 1:2975 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2534
Practice Address - Country:US
Practice Address - Phone:510-644-0200
Practice Address - Fax:510-644-2044
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11533363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant