Provider Demographics
NPI:1962737684
Name:DAVIS, LAUREN SHELTON (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:SHELTON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 -B MEDCOM ST
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-0000
Mailing Address - Country:US
Mailing Address - Phone:843-572-3330
Mailing Address - Fax:843-572-1255
Practice Address - Street 1:9150-B MEDCOM STREET
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9171
Practice Address - Country:US
Practice Address - Phone:843-572-3330
Practice Address - Fax:843-572-1255
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1473363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD043OtherGROUP MEDICARE PTAN
SC1902246077OtherARCIS HEALTHCARE GROUP NPI
SC46-2535418OtherARCIS HEALTHCARE GROUP TIN