Provider Demographics
NPI:1902865280
Name:DAVIS-GORDON, ROSEMARY (CNM)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:DAVIS-GORDON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 N IRBY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2808
Mailing Address - Country:US
Mailing Address - Phone:843-667-9414
Mailing Address - Fax:843-667-1362
Practice Address - Street 1:9 RICHLAND MEDICAL PARK DR STE 620
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6845
Practice Address - Country:US
Practice Address - Phone:803-779-6776
Practice Address - Fax:803-779-7346
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN46118176B00000X
SC298367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMW0088Medicaid
SCP94687Medicare UPIN