Healthcare Provider Details

I. General information

NPI: 1750118139
Provider Name (Legal Business Name): SAMANTHA GRETCHEN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 GARNER LN STE A
COLUMBIA SC
29210-8362
US

IV. Provider business mailing address

1345 GARNER LN STE A
COLUMBIA SC
29210-8362
US

V. Phone/Fax

Practice location:
  • Phone: 803-669-3004
  • Fax:
Mailing address:
  • Phone: 803-669-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberIHCP-2255
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: