Provider Demographics
NPI:1902203508
Name:DAVIDSON, ANASTASIA (PAAA)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PAAA
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:CHASOVSKIKH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAAA
Mailing Address - Street 1:PO BOX 102163
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2163
Mailing Address - Country:US
Mailing Address - Phone:706-543-3449
Mailing Address - Fax:706-543-5744
Practice Address - Street 1:5671 PEACHTREE DUNWOODY RD STE 530
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-5005
Practice Address - Country:US
Practice Address - Phone:706-543-3449
Practice Address - Fax:706-543-5744
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6441367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant