Provider Demographics
NPI:1700652302
Name:DAVIS, ELIJAH XIAOSEN
Entity Type:Individual
Prefix:
First Name:ELIJAH
Middle Name:XIAOSEN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 MILL RACE RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9310
Mailing Address - Country:US
Mailing Address - Phone:740-644-8855
Mailing Address - Fax:
Practice Address - Street 1:632 MILL RACE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9310
Practice Address - Country:US
Practice Address - Phone:740-644-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker