Provider Demographics
NPI:1932385960
Name:P. CARL DAVIDSON MD PC
Entity Type:Organization
Organization Name:P. CARL DAVIDSON MD PC
Other - Org Name:D/B/A DAVIDSON EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:P
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-291-7360
Mailing Address - Street 1:1013 NORTH FIFTH AVE.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2664
Mailing Address - Country:US
Mailing Address - Phone:706-291-7360
Mailing Address - Fax:706-291-8655
Practice Address - Street 1:1013 NORTH FIFTH AVE.
Practice Address - Street 2:SUITE 3
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2664
Practice Address - Country:US
Practice Address - Phone:706-291-7360
Practice Address - Fax:706-291-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029861207W00000X
GA29861207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00348895AMedicaid
D39688Medicare UPIN
GA00348895AMedicaid
GAGRP2997Medicare PIN