Healthcare Provider Details

I. General information

NPI: 1427015171
Provider Name (Legal Business Name): LUCY GREEN DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 ISLAND PARK DR STE 200
DANIEL ISLAND SC
29492-8112
US

IV. Provider business mailing address

PO BOX 530062
ATLANTA GA
30353-0062
US

V. Phone/Fax

Practice location:
  • Phone: 843-856-6402
  • Fax: 843-216-5068
Mailing address:
  • Phone: 843-695-6071
  • Fax: 843-569-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23608
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: