Healthcare Provider Details

I. General information

NPI: 1184771644
Provider Name (Legal Business Name): WESLEY DAVIS AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 E GREENVILLE ST
ANDERSON SC
29621-2062
US

IV. Provider business mailing address

1655 E GREENVILLE ST
ANDERSON SC
29621-2062
US

V. Phone/Fax

Practice location:
  • Phone: 864-716-7770
  • Fax: 864-716-7738
Mailing address:
  • Phone: 864-716-7770
  • Fax: 864-716-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: