Provider Demographics
NPI:1902865447
Name:DAVIS, TODD DRISCOLL (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:DRISCOLL
Last Name:DAVIS
Suffix:
Gender:M
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:345 FRESHFIELDS DRIVE
Practice Address - Street 2:SUITE J101
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-6323
Practice Address - Country:US
Practice Address - Phone:843-768-4800
Practice Address - Fax:843-606-8039
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30320207Q00000X
SC83446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC834468Medicaid
NC8927882Medicaid
NCC83471Medicare UPIN