Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 34647 | SC |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 2019-02562 | NC |
NPI | 1154682581 |
---|---|
Provider Name | Rachael Delee Davis |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-4300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2012 |
Last Update Date | 10/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | SC |