Healthcare Provider Details

I. General information

NPI: 1902865280
Provider Name (Legal Business Name): ROSEMARY DAVIS-GORDON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RICHLAND MEDICAL PARK DR STE 620
COLUMBIA SC
29203-6845
US

IV. Provider business mailing address

360 N IRBY ST
FLORENCE SC
29501-2808
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-6776
  • Fax: 803-779-7346
Mailing address:
  • Phone: 843-667-9414
  • Fax: 843-667-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAPN46118
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number298
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: