MEDICARE: JEROME M. DAVIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	11391	SC
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	11391	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C606001358	OTHER	SC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053370361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME M. DAVIS MD

Provider Business Mailing Address
First Line	:	1655 BERNARDIN AVE
Second Line	:	SUITE 350
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2039
Country	:	US
Telephone Number	:	803-865-4780
Fax Number	:	803-865-4932

Provider Business Practice Location Address
First Line	:	1655 BERNARDIN AVE
Second Line	:	SUITE 350
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2039
Country	:	US
Telephone Number	:	803-865-4780
Fax Number	:	803-865-4932

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	06/20/2014

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Directions to “ JEROME M. DAVIS MD” Practice Location

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