Provider Demographics
NPI:1780973867
Name:DAVIS, SHARON DENISE (MHA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 WAVERLY PLACE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7765
Mailing Address - Country:US
Mailing Address - Phone:803-467-2062
Mailing Address - Fax:
Practice Address - Street 1:1130 WAVERLY PLACE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7765
Practice Address - Country:US
Practice Address - Phone:803-467-2062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)