Healthcare Provider Details

I. General information

NPI: 1295663581
Provider Name (Legal Business Name): INDIA PATRINA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 TOWNE DR
BLUFFTON SC
29910-4201
US

IV. Provider business mailing address

213 BELLFLOWER CIR
GUYTON GA
31312-7533
US

V. Phone/Fax

Practice location:
  • Phone: 843-894-2411
  • Fax:
Mailing address:
  • Phone: 912-432-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: