Healthcare Provider Details

I. General information

NPI: 1215165741
Provider Name (Legal Business Name): WAYNE DAVIS, JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 S HIGHWAY 14 STE 1220
GREER SC
29650-4902
US

IV. Provider business mailing address

PO BOX 743070
ATLANTA GA
30374-3070
US

V. Phone/Fax

Practice location:
  • Phone: 864-849-9500
  • Fax: 864-879-3693
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31945
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: