Provider Demographics
NPI:1720728892
Name:DAVIS, EMEVASHA
Entity Type:Individual
Prefix:MISS
First Name:EMEVASHA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N BROCKINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TIMMONSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29161-1501
Mailing Address - Country:US
Mailing Address - Phone:843-420-5232
Mailing Address - Fax:843-604-0556
Practice Address - Street 1:115 N BROCKINGTON ST
Practice Address - Street 2:
Practice Address - City:TIMMONSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29161-1501
Practice Address - Country:US
Practice Address - Phone:843-420-5232
Practice Address - Fax:843-604-0556
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician