Provider Demographics
NPI:1538118252
Name:DAVIS, JANICE J (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:JANICE
Other - Middle Name:K
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:25 STONEBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8531
Mailing Address - Country:US
Mailing Address - Phone:803-781-3762
Mailing Address - Fax:
Practice Address - Street 1:167 ASHLEY AVE
Practice Address - Street 2:SUITE 525
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5836
Practice Address - Country:US
Practice Address - Phone:843-792-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC667367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0595Medicaid
SCAN0595Medicaid