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Individual

MR. CHARLES S DAVIDSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MED.,ATC.,CSCS.,CEAS

Contact information

Practice address
1930 ROYAL DR, CONWAY, AR 72034-7346
(501) 580-7670
Mailing address
1930 ROYAL DR, CONWAY, AR 72034-7346
(501) 580-7670

Taxonomy

Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
2255A2300X
Athletic Trainer
AT120
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AT120
ARKANSAS STATE BOARD OF A
AR
Enumeration date
07/30/2007
Last updated
07/30/2007
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