MEDICARE: COURTNEY DAVIS DNP

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	363L00000X	Nurse Practitioner	214204	SC

General Provider Information

NPI Number	:	1437695228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY DAVIS DNP

Provider Business Mailing Address
First Line	:	PO BOX 538622
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-8622
Country	:	US
Telephone Number	:	803-586-1212
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 CONSTITUTION BLVD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3047
Country	:	US
Telephone Number	:	910-742-9243
Fax Number	:	888-746-1787

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

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	01/17/2017

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