Provider Demographics
NPI:1073001632
Name:DECOURCEY, DANIELLE DAVIS (MD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DAVIS
Last Name:DECOURCEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4975 LACROSS ROAD SUITE 150
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:843-737-9467
Mailing Address - Fax:
Practice Address - Street 1:4975 LACROSS ROAD SUITE 150
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-1110
Practice Address - Country:US
Practice Address - Phone:843-737-9467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-28
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308417208000000X
SC86850208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics