Brent William Davidson, MD
Individual provider Active NPI Emergency Medicine Physician · Hiawassee, GA
NPI 1104874197 · NPPES record last updated Jan 5, 2010
Key facts
- NPI
- 1104874197
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 029622 (GA)
- Practice address
- 110 S Main St
Hiawassee, GA 30546-3408 - Phone
- (706) 896-2222
- Fax
- (706) 896-7872
- NPI assigned
- May 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southland Emergency Medical Services Consolidated, LLC
Southland Chatuge Emergency Medical Services, LLC
Practice addresses (Care Compare)
110 S Main St
Hiawassee, GA 30546-3408
Phone (706) 896-2222
Hospital & facility affiliations
- Chatuge Regional Hospital
- Chatuge Regional Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040304000385 | GA | Practitioner - Internal Medicine | 7719874544 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southland Emergency Medical Services Consolidated, LLC | Current |
Accepting new patients | |
| Southland Chatuge Emergency Medical Services, LLC | Emergency Medicine | Current |
Accepting new patients |
| Southland Union Emergency Medical Services, LLC | Current |
Accepting new patients | |
| Chatuge Regional Hospital Inc | Past | Accepting new patients | |
| Chatuge Regional Hospital Inc | Past | Accepting new patients | |
| Murray Medical Center, Inc. | Past | Accepting new patients | |
| United Emergency Services, Inc. | Emergency Medicine | Past | Accepting new patients |
| McMinn Medical Imaging, PC | Past | Accepting new patients |
Locations
35 Hospital Rd
Blairsville, GA 30512
Phone (706) 439-6812
145 E Peacock St
Cochran, GA 31014
Phone (229) 200-4950
110 S Main St
Hiawassee, GA 30546
Phone (706) 896-2222
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 029622 | GA | Yes |
Addresses
Primary practice location
110 S Main St
Hiawassee, GA 30546-3408
Mailing address
PO Box 509
Hiawassee, GA 30546-0509
Phone (706) 896-2222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00808585D | Medicaid | GA | |
| 89063MF | Medicaid | NC |
Other providers in Hiawassee, GA
- Tammy W Clark
- Rhonda Paige Collins
- Cynthia Coronel
- D. Bryan Johnson, MD PC
- Zachary Orlen Davenport
- Kaye Elizabeth Davis
- Alexandra Hoffman Duvall
- Katie P Dyer
- Dynamic Wellness Mobile Wound Care
- Dynamic Wellness Wound LLC
All providers in Hiawassee, GA · Emergency Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.