Individual
JEROME M. DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1655 BERNARDIN AVE, SUITE 350, COLUMBIA, SC 29204-2039
(803) 865-4780
(803) 865-4932
Mailing address
1655 BERNARDIN AVE, SUITE 350, COLUMBIA, SC 29204-2039
(803) 865-4780
(803) 865-4932
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
11391
SC
207LP2900X
Pain Medicine (Anesthesiology) Physician
11391
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113914
—
SC
01
—
C606001358
MEDICARE PTAN
SC
Enumeration date
03/23/2006
Last updated
06/20/2014
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