Provider Demographics
NPI:1558083352
Name:DAVIS, KIZZY L
Entity Type:Individual
Prefix:
First Name:KIZZY
Middle Name:L
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 1:4464 DEVINE ST STE 1241M
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3605
Mailing Address - Country:US
Mailing Address - Phone:803-667-5888
Mailing Address - Fax:
Practice Address - Street 1:3615 PERCIVAL RD LOT 75
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4275
Practice Address - Country:US
Practice Address - Phone:803-667-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor