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General NPI Number Information
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NPI Number | 1699928564
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Entity Type | Individual
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Provider Name | MR. ELIJAH DAVIS
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Gender | Male
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 2232 HEYWARD BROCKINGTON ROAD
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City | COLUMBIA
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State | SC
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Zip | 29203
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Country | US
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Telephone | 803-786-1047
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Fax | 803-714-1731
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Provider Business Mailing Address
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Address Line | P.O. BOX 3273
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City | COLUMBIA
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State | SC
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Zip | 29230
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Country | US
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Telephone | 803-786-1047
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Fax | 803-714-1731
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | CRC-240
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | CRC-538
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License Number State | SC
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