Healthcare Provider Details

I. General information

NPI: 1235756578
Provider Name (Legal Business Name): JOEL CHRISTOPHER DAVIES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 RUTLEDGE AVE
CHARLESTON SC
29425-8903
US

IV. Provider business mailing address

66 BARRE ST
CHARLESTON SC
29401-1106
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-0719
  • Fax:
Mailing address:
  • Phone: 647-984-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number84706
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: