Provider Demographics
NPI:1104419738
Name:DAVIDSON-SMITH, CHAVONN DONE
Entity type:Individual
Prefix:
First Name:CHAVONN
Middle Name:DONE
Last Name:DAVIDSON-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NORWELL CT
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3450
Mailing Address - Country:US
Mailing Address - Phone:770-634-7470
Mailing Address - Fax:
Practice Address - Street 1:3000 NORWELL CT
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3450
Practice Address - Country:US
Practice Address - Phone:770-634-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195874363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health