Active NPI
Charles S Davidson, MED.,ATC.,CSCS.,CEAS
- Rehabilitation Practitioner
- Conway, AR
National Provider Identifier
1891985438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 1930 Royal Dr
Conway, AR 72034-7346 - Phone
- (501) 580-7670
- NPI assigned
- Jul 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | Primary | ||
| Athletic Trainer | 2255A2300X | AT120 | AR |
Addresses
Primary practice location
1930 Royal Dr
Conway, AR 72034-7346
Mailing address
1930 Royal Dr
Conway, AR 72034-7346
Phone (501) 580-7670
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AT120 | Other | AR | ARKANSAS STATE BOARD OF A |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT120 | AR | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185753600000",
"number": "1891985438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1930 ROYAL DR",
"city": "CONWAY",
"state": "AR",
"postal_code": "720347346",
"telephone_number": "501-580-7670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1930 ROYAL DR",
"city": "CONWAY",
"state": "AR",
"postal_code": "720347346",
"telephone_number": "501-580-7670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "CHARLES",
"middle_name": "S",
"name_prefix": "Mr.",
"credential": "MED.,ATC.,CSCS.,CEAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-30",
"last_updated": "2007-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AR",
"license": "AT120",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARKANSAS STATE BOARD OF A",
"identifier": "AT120",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conway, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.