Basic Information
| Provider Information | |||||||||
| NPI: | 1053316943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 FOUNDRY HILL RD | ||||||||
| Address2: | |||||||||
| City: | CHERAW | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295202500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778481463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 34 FOUNDRY HILL RD | ||||||||
| Address2: | |||||||||
| City: | CHERAW | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295202500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778481463 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 17273 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 17273 | SC | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 890065YN | 05 | NC | MEDICAID | 172734 | 05 | SC | MEDICAID | 184433 | 01 | SC | UNISON | OTHER | 20019649 | 01 | SC | SELECT HEALTH | OTHER |