Provider Demographics
NPI:1316916992
Name:DR. N.W. DAVIS, P.A.
Entity type:Organization
Organization Name:DR. N.W. DAVIS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORDEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:864-489-6593
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29342-0490
Mailing Address - Country:US
Mailing Address - Phone:864-489-6593
Mailing Address - Fax:864-489-5040
Practice Address - Street 1:300 N LOGAN ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2320
Practice Address - Country:US
Practice Address - Phone:864-489-6593
Practice Address - Fax:864-489-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC436152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDM0293Medicaid
SCD04369Medicaid
SC0373350001Medicare PIN
SCT243400281Medicare UPIN