Provider Demographics
NPI:1477269678
Name:DAVIS, ELLISHA
Entity Type:Individual
Prefix:
First Name:ELLISHA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 PENDLETON ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3232
Mailing Address - Country:US
Mailing Address - Phone:864-775-4900
Mailing Address - Fax:864-751-4353
Practice Address - Street 1:726 LOWNDES HILL RD STE E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2117
Practice Address - Country:US
Practice Address - Phone:864-775-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38404174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist