Provider Demographics
NPI:1710965280
Name:DAVIDSON, GERALD ALLEN (BA, BSN, MSHS, CRNA)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ALLEN
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:BA, BSN, MSHS, CRNA
Other - Prefix:
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Mailing Address - Street 1:713 WINDCHIME ALY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7829
Mailing Address - Country:US
Mailing Address - Phone:843-437-4951
Mailing Address - Fax:843-216-0477
Practice Address - Street 1:606 BLACK RIVER RD
Practice Address - Street 2:GEORGETOWN MEMORIAL HOSP ANESTHESI
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3304
Practice Address - Country:US
Practice Address - Phone:843-527-7000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCAPN 1312367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered