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NPI Code Detail

MEDICARE: SALLEY B DAVIDSON M. AUD., CCC-A

MEDICARE:   SALLEY B DAVIDSON  M. AUD., CCC-A
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
1237600000XAudiologist-Hearing Aid Fitter275SC

General Provider Information

NPI Number : 1720237654
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLEY B DAVIDSON M. AUD., CCC-A
Provider Business Mailing Address
First Line : 497 SAINT ANDREWS BLVD
Second Line :
City : CHARLESTON
State : SC
Zip : 29407-7184
Country : US
Telephone Number : 843-763-0544
Fax Number : 843-576-2089
Provider Business Practice Location Address
First Line : 497 SAINT ANDREWS BLVD
Second Line :
City : CHARLESTON
State : SC
Zip : 29407-7184
Country : US
Telephone Number : 843-763-0544
Fax Number : 843-576-2089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2008
Last Update Date : 04/19/2011

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Directions to “ SALLEY B DAVIDSON M. AUD., CCC-A” Practice Location

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