Individual provider Active NPI

Evan Davidson, DPT

  • Physical Therapist
  • Riverdale, GA
National Provider Identifier
1649029356
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT017566 Issued in GA
Practice address
155 Medical Way Ste a
Riverdale, GA 30274-4940
Phone
(770) 991-2747
NPI assigned
May 15, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Physical Therapist 225100000X PT017566 GA Primary

Addresses

Primary practice location

155 Medical Way Ste a
Riverdale, GA 30274-4940

Mailing address

1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (866) 518-0283

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250213003603 GA Practitioner - Physical Therapist in Private Practice 7113457565 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Benchmark Physical Therapy, IncGroup PAC ID 1557395209, 69 clinicians

Practice addresses (Care Compare)

155 Medical Way a
Riverdale, GA 30274-4940
Phone (770) 991-2747

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Independent Physical Therapy of Ga, LLC Physical Therapist CurrentSince Jan 16, 2025 Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist CurrentSince Jan 16, 2025 Accepting new patients
Agilitas USA Inc Physical Therapist CurrentSince Jan 16, 2025 Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist Current Accepting new patients
Benchmark Physical Therapy, Inc CurrentSince Jan 16, 2025 Accepting new patients
Agilitas USA, Inc Physical Therapist CurrentSince Jan 16, 2025 Accepting new patients
Benchmark Physical Therapy, Inc CurrentSince Jan 16, 2025 Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

1025 E West Connector
Ste 406
Austell, GA 30106
Phone (770) 384-1001

7130 Mount Zion Blvd
Ste 9
Jonesboro, GA 30236
Phone (770) 603-5660

155 Medical Way
Ste A
Riverdale, GA 30274
Phone (770) 991-2747

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1649029356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "866-518-0283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 MEDICAL WAY STE A",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302744940",
            "telephone_number": "770-991-2747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "EVAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-15",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT017566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.