Provider Demographics
NPI:1558412478
Name:DAVIDSON, JASON D (OPA-C, OTC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:OPA-C, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 MONTCLAIR RD
Mailing Address - Street 2:SUITE 577
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1972
Mailing Address - Country:US
Mailing Address - Phone:205-595-6757
Mailing Address - Fax:205-595-0472
Practice Address - Street 1:880 MONTCLAIR RD
Practice Address - Street 2:SUITE 577
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1972
Practice Address - Country:US
Practice Address - Phone:205-595-6757
Practice Address - Fax:205-595-0472
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00-0011246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist