Provider Demographics
NPI:1427015171
Name:DAVIS, LUCY GREEN (MD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:GREEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:899 ISLAND PARK DR
Practice Address - Street 2:STE 200
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8112
Practice Address - Country:US
Practice Address - Phone:843-856-6402
Practice Address - Fax:843-216-5068
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00023765OtherMEDICARE RAIL ROAD
SC236088Medicaid
SCAA60457126Medicare PIN
SCH841286868Medicare PIN
SCP00023765OtherMEDICARE RAIL ROAD