Provider Demographics
NPI:1598737678
Name:DAVIS, DEBORAH J (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
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 1:1228 HARDEN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-1800
Mailing Address - Country:US
Mailing Address - Phone:803-744-0540
Mailing Address - Fax:803-744-0542
Practice Address - Street 1:1228 HARDEN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1800
Practice Address - Country:US
Practice Address - Phone:803-744-0540
Practice Address - Fax:803-744-0542
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12761207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC127614Medicaid
SC127614Medicaid