Provider Demographics
NPI:1629520242
Name:DAVISON, CAROL (RN, BSN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:DAVISON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 LAFAYETTE CIR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-2569
Mailing Address - Country:US
Mailing Address - Phone:843-527-1013
Mailing Address - Fax:
Practice Address - Street 1:531 LAFAYETTE CIR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2569
Practice Address - Country:US
Practice Address - Phone:843-527-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN .47558 R163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse