Provider Demographics
NPI:1689845059
Name:DAVIDSON, LEE P (RPH)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:P
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 BIRDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-6018
Mailing Address - Country:US
Mailing Address - Phone:706-373-4818
Mailing Address - Fax:
Practice Address - Street 1:483 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-3912
Practice Address - Country:US
Practice Address - Phone:706-738-4558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist