Provider Demographics
NPI:1245864214
Name:DAVIDSON, MAHLON LYNN (RPH)
Entity type:Individual
Prefix:
First Name:MAHLON
Middle Name:LYNN
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 1:5341 HIGHWAY 20 S
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-4409
Mailing Address - Country:US
Mailing Address - Phone:770-788-4008
Mailing Address - Fax:678-342-7573
Practice Address - Street 1:5341 HIGHWAY 20 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-4409
Practice Address - Country:US
Practice Address - Phone:770-788-4008
Practice Address - Fax:678-342-7573
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0137981835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist