Individual
MR. ELIJAH DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2232 HEYWARD BROCKINGTON ROAD, COLUMBIA, SC 29203
(803) 786-1047
(803) 714-1731
Mailing address
P.O. BOX 3273, COLUMBIA, SC 29230
(803) 786-1047
(803) 714-1731
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
CRC-240
SC
310400000X
Assisted Living Facility
CRC-538
SC
Other
Enumeration date
10/23/2008
Last updated
10/23/2008
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