Provider Demographics
NPI:1760648182
Name:DAVIDSON, JOANNE K (NP-C)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:K
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:125 DOUGHTY ST
Practice Address - Street 2:STE 690
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5736
Practice Address - Country:US
Practice Address - Phone:843-720-8490
Practice Address - Fax:843-727-3602
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA 3588363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5551OtherMEDICARE GROUP #
SCGP4799OtherMEDICAID GROUP #
SCNP1270Medicaid
SCGP4799OtherMEDICAID GROUP #