Provider Demographics
NPI:1922216290
Name:DAVIDSON, YOLANDA YVETTE
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:YVETTE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 CENTRAL AVE APT 309
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4875
Mailing Address - Country:US
Mailing Address - Phone:601-435-5990
Mailing Address - Fax:
Practice Address - Street 1:1437 CENTRAL AVE APT 309
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4875
Practice Address - Country:US
Practice Address - Phone:601-435-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician