Provider Demographics
NPI:1194706382
Name:DAVIDSON SURGICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:DAVIDSON SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH, II
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-475-7148
Mailing Address - Street 1:1219 LEXINGTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-2870
Mailing Address - Country:US
Mailing Address - Phone:336-475-7148
Mailing Address - Fax:336-475-7031
Practice Address - Street 1:1219 LEXINGTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2870
Practice Address - Country:US
Practice Address - Phone:336-475-7148
Practice Address - Fax:336-475-7031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39915208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01426OtherBCBS OF NC PROVIDER #
NC8901426Medicaid
NC8901426Medicaid