Provider Demographics
NPI:1790830768
Name:DAVIDSON, CHRISTOPHER JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:DAVIDSON
Suffix:
Gender:M
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:706-373-4817
Mailing Address - Fax:706-792-5130
Practice Address - Street 1:3121 PEACH ORCHARD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3521
Practice Address - Country:US
Practice Address - Phone:706-792-5130
Practice Address - Fax:706-792-5132
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH017583OtherSTATE LICENSE #