Provider Demographics
NPI:1972509925
Name:DAVIS, DONEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DONEN
Middle Name:
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 1:1850 LAUREL ST
Mailing Address - Street 2:STE B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2627
Mailing Address - Country:US
Mailing Address - Phone:803-929-1901
Mailing Address - Fax:803-929-1916
Practice Address - Street 1:1850 LAUREL ST
Practice Address - Street 2:STE B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2627
Practice Address - Country:US
Practice Address - Phone:803-929-1901
Practice Address - Fax:803-929-1916
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21726208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3919Medicaid
SCH57506Medicare UPIN