Provider Demographics
NPI:1831226331
Name:DAVIS, DAVID OLIVER (APRN)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:OLIVER
Last Name:DAVIS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3860
Mailing Address - Country:US
Mailing Address - Phone:864-725-4650
Mailing Address - Fax:864-725-4452
Practice Address - Street 1:1325 SPRING ST
Practice Address - Street 2:SELF REGIONAL HEALTHCARE NEONATOLOGY
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3860
Practice Address - Country:US
Practice Address - Phone:864-725-4650
Practice Address - Fax:864-725-4452
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 195363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care