Healthcare Provider Details

I. General information

NPI: 1518834167
Provider Name (Legal Business Name): CLOVIS AI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 BELLEVUE AVE
DAYTONA BEACH FL
32114-5615
US

IV. Provider business mailing address

PO BOX 548
SIMPSONVILLE SC
29681-0548
US

V. Phone/Fax

Practice location:
  • Phone: 772-475-2277
  • Fax: 888-877-3919
Mailing address:
  • Phone: 321-626-6164
  • Fax: 888-877-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: GARRETT SOWARDS
Title or Position: CFO
Credential:
Phone: 321-626-6164