Provider Demographics
NPI:1679679922
Name:DAVIDSON, JAMES V (MA CCCA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W FAULKNER
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-862-5339
Mailing Address - Fax:870-862-7571
Practice Address - Street 1:530 W FAULKNER
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:870-862-5339
Practice Address - Fax:870-862-7571
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR42231H00000X
AR229237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114404720OtherMCAID PAY TO
AR106174720Medicaid
R01938Medicare UPIN
AR106174720Medicaid