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NPI Code Detail

MEDICARE: MARK A DAVIS PA-C

MEDICARE: MARK A DAVIS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA2841SC

General Provider Information

NPI Number : 1073586186
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK A DAVIS PA-C
Provider Business Mailing Address
First Line : 2611 FOREST DR STE 200
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2371
Country : US
Telephone Number : 803-779-3263
Fax Number : 803-779-3207
Provider Business Practice Location Address
First Line : 2611 FOREST DR STE 200
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2371
Country : US
Telephone Number : 803-779-3263
Fax Number : 803-779-3207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 04/20/2018

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Directions to “ MARK A DAVIS PA-C” Practice Location

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