Provider Demographics
NPI:1457317075
Name:DAVIDSON, DEANNA (MD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
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:PO BOX 15035
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-0035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2895 STUART TER
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-6106
Practice Address - Country:US
Practice Address - Phone:423-875-5195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0153422085R0001X
MI43011111212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457317075Medicaid
VA343699OtherANTHEM
VAPAROtherVIRGINIA HEALTH NETWORK
NC08761OtherNC BC/BS
VA2177941OtherUHC/MAMSI
VA7333375OtherCIGNA
VAPAROtherUSA MANAGED CARE
VA5748084OtherAETNA
VAPAROtherMULTIPLAN
VAPAROtherCORVEL/CORCARE
NC5908761Medicaid
VAPAROtherVA PREMIER HEALTH
VA1457317075OtherSENTARA/OPTIMA
VAPAROtherTRICARE CHAMPUS
VAPAROtherFIRST HEALTH COMMERCIAL
VA2177941OtherUHC/MAMSI
A97869Medicare UPIN
VA1457317075OtherSENTARA/OPTIMA