Provider Demographics
NPI:1033939988
Name:DAVIDSON, JAMES TODD (CARES, CPS-AD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:TODD
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:CARES, CPS-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-0008
Mailing Address - Country:US
Mailing Address - Phone:706-212-0349
Mailing Address - Fax:
Practice Address - Street 1:151 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-4244
Practice Address - Country:US
Practice Address - Phone:706-212-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist