Provider Demographics
NPI:1295753622
Name:DAVIS-TOLBERT, ARDRA R (MD)
Entity type:Individual
Prefix:
First Name:ARDRA
Middle Name:R
Last Name:DAVIS-TOLBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 RIBAUT ROAD
Mailing Address - Street 2:BUILDING 200
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902
Mailing Address - Country:US
Mailing Address - Phone:843-524-5455
Mailing Address - Fax:843-524-5655
Practice Address - Street 1:75 BAYLOR DR
Practice Address - Street 2:STE 200
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8965
Practice Address - Country:US
Practice Address - Phone:843-540-5857
Practice Address - Fax:843-524-5655
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC225851207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC225851Medicaid
SCI27826Medicare UPIN
SC225851Medicaid