Healthcare Provider Details

I. General information

NPI: 1316382104
Provider Name (Legal Business Name): CHARLOTTE DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8548 WILLTOWN RD
YONGES ISLAND SC
29449-5515
US

IV. Provider business mailing address

8548 WILLTOWN RD
YONGES ISLAND SC
29449-5515
US

V. Phone/Fax

Practice location:
  • Phone: 843-880-4008
  • Fax: 843-889-6758
Mailing address:
  • Phone: 843-880-4008
  • Fax: 843-889-6758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number80443
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: