Healthcare Provider Details

I. General information

NPI: 1396660619
Provider Name (Legal Business Name): COOPER DAVIS TOY NRAEMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 E MANNING ST
MARION SC
29571-3115
US

IV. Provider business mailing address

614 E MANNING ST
MARION SC
29571-3115
US

V. Phone/Fax

Practice location:
  • Phone: 843-367-8972
  • Fax:
Mailing address:
  • Phone: 843-367-8972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License NumberSC606948
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License NumberP574193
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: