Healthcare Provider Details

I. General information

NPI: 1073001632
Provider Name (Legal Business Name): DANIELLE DAVIS DECOURCEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2018
Last Update Date: 06/26/2023
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4975 LACROSS ROAD SUITE 150
NORTH CHARLESTON SC
29406-1110
US

IV. Provider business mailing address

4975 LACROSS ROAD SUITE 150
NORTH CHARLESTON SC
29406
US

V. Phone/Fax

Practice location:
  • Phone: 843-737-9467
  • Fax:
Mailing address:
  • Phone: 843-737-9467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number308417
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number86850
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: