Provider Demographics
NPI:1629228887
Name:DAVIDSON, BENJAMIN A (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:A
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35064-1430
Mailing Address - Country:US
Mailing Address - Phone:205-785-1353
Mailing Address - Fax:205-785-3731
Practice Address - Street 1:4614 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:AL
Practice Address - Zip Code:35064-1430
Practice Address - Country:US
Practice Address - Phone:205-785-1353
Practice Address - Fax:205-785-3731
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-16445OtherBLUECROSS BLUESHIELD
AL1629228887Medicaid