Healthcare Provider Details

I. General information

NPI: 1740600402
Provider Name (Legal Business Name): CATHERINE SUZANNE DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE DAVIS SHOLES M.D.

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 STUARD ST
GAFFNEY SC
29341-1263
US

IV. Provider business mailing address

PO BOX 277723
ATLANTA GA
30384-7723
US

V. Phone/Fax

Practice location:
  • Phone: 864-514-1080
  • Fax: 864-514-1090
Mailing address:
  • Phone: 864-560-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number28923
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28923
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number28923
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number83694
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: