Individual
LAUREN SHELTON DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9150-B MEDCOM STREET, NORTH CHARLESTON, SC 29406-9171
(843) 572-3330
(843) 572-1255
Mailing address
9150 -B MEDCOM ST, N CHARLESTON, SC 29406-0000
(843) 572-3330
(843) 572-1255
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1473
SC
363AS0400X
Surgical Physician Assistant
1473
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D043
GROUP MEDICARE PTAN
SC
Enumeration date
10/14/2009
Last updated
06/03/2015
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