Provider Demographics
NPI:1922594662
Name:DAVIS, ALISHA JANETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:JANETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:ALISHA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8611
Mailing Address - Fax:
Practice Address - Street 1:129 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4949
Practice Address - Country:US
Practice Address - Phone:803-774-9680
Practice Address - Fax:803-434-3955
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC520788Medicaid
SCSCJ6985019OtherMEDICARE PIN