Provider Demographics
NPI:1487417747
Name:DAVIS, ASIA ALEXANDRA
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:ALEXANDRA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 HULON LN
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3444
Mailing Address - Country:US
Mailing Address - Phone:803-904-4174
Mailing Address - Fax:
Practice Address - Street 1:1110 HULON LN
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3444
Practice Address - Country:US
Practice Address - Phone:803-904-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide