Provider Demographics
NPI:1689383598
Name:DAVIDSON, ZACHARY DOUGLAS (PRS)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DOUGLAS
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1846
Mailing Address - Country:US
Mailing Address - Phone:740-283-4649
Mailing Address - Fax:740-314-4051
Practice Address - Street 1:1010 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1846
Practice Address - Country:US
Practice Address - Phone:740-283-4649
Practice Address - Fax:740-314-4051
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.003654175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist