NPIMap

Organization Active NPI

P. Carl Davidson MD PC

  • Ophthalmology Physician
  • Summerville, GA
National Provider Identifier
1932385960
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
29861 Issued in GA
Legal business name
P. CARL DAVIDSON MD PC
Practice address
10366 Commerce St
Summerville, GA 30747-1471
Phone
(706) 857-7777
Fax
(706) 857-7877
NPI assigned
Jan 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

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

Authorized official

Name
P Carl Davidson, MDNPI 1295701704
Title
Owner
Phone
(706) 291-7360

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 29861 GA Primary

Addresses

Primary practice location

10366 Commerce St
Summerville, GA 30747-1471

Mailing address

1403 Cinderella Rd
Lookout MTN, GA 30750-2610
Phone (706) 346-8629

Other names 1

  • D/B/A Davidson Eye Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040416000256 GA Part B Supplier - Clinic/Group Practice 2163417528 Receives reassigned benefits from 1 practitioner
Practice locations: Summerville, GA

National Provider Directory

National Provider Directory

Locations

1013 N 5th Ave NE
Ste 3
Rome, GA 30165
Phone (706) 291-7360

10366 Commerce St
Summerville, GA 30747
Phone (706) 346-8629

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1200960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736467200000",
    "number": "1932385960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 CINDERELLA RD",
            "city": "LOOKOUT MTN",
            "state": "GA",
            "postal_code": "307502610",
            "telephone_number": "706-346-8629",
            "fax_number": "706-346-8629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10366 COMMERCE ST",
            "city": "SUMMERVILLE",
            "state": "GA",
            "postal_code": "307471471",
            "telephone_number": "706-857-7777",
            "fax_number": "706-857-7877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P. CARL DAVIDSON MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-22",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "P",
        "authorized_official_middle_name": "CARL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-291-7360",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "GA",
            "license": "29861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "D/B/A Davidson Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Summerville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.