Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 36241 | SC |
N | 207RG0300X | Geriatric Medicine | G32480 | CA |
NPI | 1134154735 |
---|---|
Provider Name | James William Davis JR. |
First Address | Greenville, SC 29615-4545 |
Second Address | Greenville, SC 29615-6300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 25/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G324800 | (05) | CA |
362413 | (05) | SC |
A91448 | (02) | CA |