Melissa M Davidson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

002192 Issued in GA

Practice address

4800 Olde Towne Pkwy Ste 150a
Marietta, GA 30068-4357

Phone

(770) 509-1025

Fax

(770) 509-1884

NPI assigned

May 20, 2006

Last updated

Feb 26, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northside Emergency Associates, LLC

  • Emergency Medicine Physician
  • Sandy Springs, GA
  • NPI 1285686303
  Medicare reassignment
• Athens Radiology Associates PC

  • Diagnostic Radiology Physician
  • Athens, GA
  • NPI 1932189685
  NPD (past)
• Athens-Clarke Emergency Specialists

  • Emergency Medicine Physician
  • Athens, GA
  • NPI 1194762237
  NPD (past)
• ENT of Georgia, LLC

  • Otolaryngology Physician
  • Atlanta, GA
  • NPI 1922046424
  NPD (past)
• University Surgical Associates of Athens

  dba University Vascular

  • Specialist
  • Watkinsville, GA
  • NPI 1861500183
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1578517876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2968",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301569117",
            "telephone_number": "770-779-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 OLDE TOWNE PKWY STE 150A",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300684357",
            "telephone_number": "770-509-1025",
            "fax_number": "770-509-1884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "MELISSA",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-20",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "002192",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "002192",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001575B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "333457",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001575",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001575C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10038125",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "NFMUC_EastCobb@Northside.gwaydirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "4800 Olde Towne Pkwy Ste 150A",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300684357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Pooja Niranjan Dave, PH.D.
• Katie Marie Davenport, DPT, PT
• David Koentop
• Thomas J David, DDS
• Kristal Sheree Davidson, LPC, NCC
• Stephanie Davidson
• Todd Lynn Davidson, PHARM.D.
• Manuel A. Davila, D.M.D.
• Torey Charlise Davis-Bogan, SA-C, CST
• Nikkita Davis-Gulley

• Physician Assistant in Marietta, GA
• Providers in Marietta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.