Provider Demographics
NPI:1306154885
Name:DAVIDSON, CHARLES ANDREW (PHD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANDREW
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:CHARLIE
Other - Middle Name:ANDREW
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1784 CENTURY BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3313
Mailing Address - Country:US
Mailing Address - Phone:402-370-6778
Mailing Address - Fax:
Practice Address - Street 1:1784 CENTURY BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3313
Practice Address - Country:US
Practice Address - Phone:402-370-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-19
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GAPSY004112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPSY004112OtherPSYCHOLOGIST LICENSE