Healthcare Provider Details

I. General information

NPI: 1295753622
Provider Name (Legal Business Name): ARDRA R DAVIS-TOLBERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BAYLOR DR STE 200
BLUFFTON SC
29910-8965
US

IV. Provider business mailing address

1264 RIBAUT ROAD BUILDING 200
BEAUFORT SC
29902
US

V. Phone/Fax

Practice location:
  • Phone: 843-540-5857
  • Fax: 843-524-5655
Mailing address:
  • Phone: 843-524-5455
  • Fax: 843-524-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number225851
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: