Provider Demographics
NPI:1639519903
Name:DAVIDSON, CASEY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:THOMAS
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 1:3000 EDWARD CURD LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5791
Mailing Address - Country:US
Mailing Address - Phone:615-791-2630
Mailing Address - Fax:615-791-2639
Practice Address - Street 1:3000 EDWARD CURD LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5791
Practice Address - Country:US
Practice Address - Phone:615-791-2630
Practice Address - Fax:615-791-2639
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-00495207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1639519903Medicaid
SCNC3381Medicaid
NC0397730004OtherNSC #