Provider Demographics
NPI:1750567848
Name:DAVIS, SUSAN ROYAL (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ROYAL
Last Name:DAVIS
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 1:7257 SWEET GRASS BLVD
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-4706
Mailing Address - Country:US
Mailing Address - Phone:843-793-1824
Mailing Address - Fax:843-793-1824
Practice Address - Street 1:7257 SWEET GRASS BLVD
Practice Address - Street 2:
Practice Address - City:HANAHAN
Practice Address - State:SC
Practice Address - Zip Code:29410-4706
Practice Address - Country:US
Practice Address - Phone:843-793-1824
Practice Address - Fax:843-793-1824
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059439171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor