Provider Demographics
NPI:1811958812
Name:DAVIDSON FAMILY MEDICINE, P.A.
Entity type:Organization
Organization Name:DAVIDSON FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VONE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-892-5454
Mailing Address - Street 1:PO BOX 4329
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-4329
Mailing Address - Country:US
Mailing Address - Phone:704-892-5454
Mailing Address - Fax:704-892-5858
Practice Address - Street 1:104 KNOX COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-4329
Practice Address - Country:US
Practice Address - Phone:704-892-5454
Practice Address - Fax:704-892-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty