MEDICARE: MERCEDES ZIMMERMAN 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	001000495	NC
2	363A00000X	Physician Assistant	MA054212	PA
3	363A00000X	Physician Assistant	PA2292	SC

General Provider Information

NPI Number	:	1831204676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCEDES ZIMMERMAN DAVIS PA-C

Provider Business Mailing Address
First Line	:	106 LANSFORD PL
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6979
Country	:	US
Telephone Number	:	843-293-8850
Fax Number	:	843-293-8860

Provider Business Practice Location Address
First Line	:	106 LANSFORD PL
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6979
Country	:	US
Telephone Number	:	843-293-8850
Fax Number	:	843-293-8860

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	11/23/2016

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