Healthcare Provider Details

I. General information

NPI: 1598687857
Provider Name (Legal Business Name): HEATH DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 PEBBLE CREEK RD
COLUMBIA SC
29223-3113
US

IV. Provider business mailing address

116 PEBBLE CREEK RD
COLUMBIA SC
29223-3113
US

V. Phone/Fax

Practice location:
  • Phone: 803-240-5669
  • Fax:
Mailing address:
  • Phone: 803-240-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
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: