Provider Demographics
NPI:1508963539
Name:DAVIDSON, JEREMY SCOTT (PAC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:SCOTT
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-7776
Mailing Address - Country:US
Mailing Address - Phone:828-274-6003
Mailing Address - Fax:828-274-6004
Practice Address - Street 1:1119 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-7776
Practice Address - Country:US
Practice Address - Phone:828-274-6003
Practice Address - Fax:828-274-6004
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00771670OtherMEDICARE RAILROAD
NC2763677AMedicare PIN
P71425Medicare UPIN