Provider Demographics
NPI:1457317075
Name:DAVIDSON, DEANNA S (MD)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:S
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15035
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-0035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:803 W MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2796
Practice Address - Country:US
Practice Address - Phone:419-996-5063
Practice Address - Fax:419-996-5502
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN629352085R0001X
TN0153422085R0001X
MI43011111212085R0001X
OH351257422085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherTRICARE CHAMPUS
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERCIAL
VA1457317075Medicaid
VA2177941OtherUHC/MAMSI
NC5908761Medicaid
VAPAROtherCORVEL/CORCARE
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherVA PREMIER HEALTH
VAPAROtherMULTIPLAN
NC08761OtherNC BC/BS
VA1457317075OtherSENTARA/OPTIMA
VA343699OtherANTHEM
VA5748084OtherAETNA
VA7333375OtherCIGNA
VA2177941OtherUHC/MAMSI
A97869Medicare UPIN
VA1457317075OtherSENTARA/OPTIMA