Provider Demographics
NPI:1740600402
Name:DAVIS, CATHERINE SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:SUZANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:DAVIS
Other - Last Name:SHOLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 277723
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7723
Mailing Address - Country:US
Mailing Address - Phone:864-560-6000
Mailing Address - Fax:
Practice Address - Street 1:103 STUARD ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1263
Practice Address - Country:US
Practice Address - Phone:864-514-1080
Practice Address - Fax:864-514-1090
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28923171000000X, 208000000X, 208D00000X
SC83694208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No171000000XOther Service ProvidersMilitary Health Care Provider
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC836947Medicaid
SCSCK5265019OtherMEDICARE PIN
SCSCK526J577OtherMEDICARE PIN
SCSCK526H895OtherMEDICARE PIN