Individual
ANDREW JEREMIAH DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
STUDENT
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(214) 668-9607
Mailing address
6232 MISSISSIPPI ST, CAMP LEJEUNE, NC 28547-2532
(214) 668-9607
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
23588888
TX
363A00000X
Physician Assistant
Primary
—
MD
390200000X
Student in an Organized Health Care Education/Training Program
23588888
NC
Other
Enumeration date
08/10/2016
Last updated
03/11/2026
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