Organization
MEGGETT TIVA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID RAEDORD DAVIS CRNA (OWNER)
(843) 860-0324
Entity
Organization
Contact information
Practice address
4731 HIGHWAY 17, MURRELLS INLET, SC 29576-5090
(843) 839-7246
(843) 491-4023
Mailing address
PO BOX 4860, MURRELLS INLET, SC 29576-2698
(843) 651-2624
(843) 491-4023
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2255
SC
Other
Enumeration date
08/24/2016
Last updated
08/24/2016
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