1770605925 NPI number — DAVIS AND DAVIS HEALTH CENTER

Table of content: (NPI 1770605925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770605925 NPI number — DAVIS AND DAVIS HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVIS AND DAVIS HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770605925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 GRANBURY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29229-7556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-712-1911
Provider Business Mailing Address Fax Number:
803-760-1888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1089 COLUMBIA ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINNSBORO
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-712-1911
Provider Business Practice Location Address Fax Number:
803-760-1888
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
ONEYKE
Authorized Official Middle Name:
NAPU
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
803-712-1911

Provider Taxonomy Codes

  • Taxonomy code: 111NI0900X , with the licence number:  2146 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH2283 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH2146 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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