Healthcare Provider Details

I. General information

NPI: 1992332092
Provider Name (Legal Business Name): DAVIS COPELAND DIAMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 SERPENTINE DR STE 440
SPARTANBURG SC
29303-3081
US

IV. Provider business mailing address

300 ASHBY PARK LN
GREENVILLE SC
29607-6903
US

V. Phone/Fax

Practice location:
  • Phone: 864-410-1973
  • Fax: 864-288-2554
Mailing address:
  • Phone: 864-288-1154
  • Fax: 864-288-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number94051
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: