Provider Demographics
NPI:1790858991
Name:DAVIDSON, AARON HERSHEL (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:HERSHEL
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E INMAN ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5124
Mailing Address - Country:US
Mailing Address - Phone:912-489-3678
Mailing Address - Fax:
Practice Address - Street 1:911 E INMAN ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5124
Practice Address - Country:US
Practice Address - Phone:912-489-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032717207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00445695BMedicaid
58-2263734OtherEIN-FEDERAL TAX NUMBER
GA00445695BMedicaid
18BDBZZMedicare ID - Type Unspecified