MEDICARE: CHRISTOPHER ANDREW 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
1	363A00000X	Physician Assistant	2181	SC

General Provider Information

NPI Number	:	1114328408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER ANDREW DAVIS PA-C

Provider Business Mailing Address
First Line	:	4969 CENTRE POINTE DR
Second Line	:	SUITE 100
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-6952
Country	:	US
Telephone Number	:	843-853-0250
Fax Number	:	843-853-0210

Provider Business Practice Location Address
First Line	:	4969 CENTRE POINTE DR
Second Line	:	SUITE 100
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-6952
Country	:	US
Telephone Number	:	843-853-0250
Fax Number	:	843-853-0210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2014
Last Update Date	:	10/30/2014

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