Provider Demographics
NPI:1134225931
Name:DAVIDSON, JASON ARTHUR
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ARTHUR
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JOHN MADDOX DR NW
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1431
Mailing Address - Country:US
Mailing Address - Phone:706-368-8022
Mailing Address - Fax:
Practice Address - Street 1:100 JOHN MADDOX DR NW
Practice Address - Street 2:SUITE A-4
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1431
Practice Address - Country:US
Practice Address - Phone:706-368-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1768111N00000X
GA005903367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
No111N00000XChiropractic ProvidersChiropractor