Provider Demographics
NPI:1376083089
Name:DAVIS, ERIC R
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 RED CLOVER PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-3007
Mailing Address - Country:US
Mailing Address - Phone:614-571-1351
Mailing Address - Fax:614-929-3230
Practice Address - Street 1:3540 RED CLOVER PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-3007
Practice Address - Country:US
Practice Address - Phone:614-571-1351
Practice Address - Fax:614-929-3230
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHST170576374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide