CHARLES BRADFORD DAVIS (NPI# 1861957516) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861957516 |
| Entity Type | Individual |
| Full Name | CHARLES BRADFORD DAVIS |
| Other Name | CHARLES B DAVIS |
| Practice Address |
411 Polifka Dr Shaw Afb SC 29152 |
| Mailing Address |
5590 Pershing Dr Dalzell SC 29040-9413 |
| Practice Telephone | 8283616979 |
| Mailing Telephone | 8283616979 |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2019-02-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCCPA NUMBER | 1161436 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447726435 | Charles Wayne Davis | Pharmacist | 1900 Patterson St Ste 200, Nashville, TN 37203-2167 | 2018-10-17 |
| 1588073175 | Charles R. Davis Jr. | Home Health Aide | 436 E Carpenter Dr, New Carlisle, OH 45344-2529 | 2014-08-07 |
| 1841601739 | Charles Davis | Pharmacist | 4333 W. Pierson Rd. G, Flint, MI 48504 | 2014-05-13 |
| 1285055715 | Charles Andre Davis | Counselor | 1211 Putnam Ave, Brooklyn, NY 11221-4909 | 2013-12-31 |
| 1154669026 | Charles King Davis Jr. | Surgery | 755 Woodland Dr, Paducah, KY 42001-4677 | 2013-01-28 |
| 1417260936 | Charles A Davis Jr. | Dentist | 303 S Boulevard, Apt 10, Richmond, VA 23220-5769 | 2010-07-26 |
| 1417287160 | Charles F Davis | Physical Therapist | 232 Oleander Ave, Palm Beach, FL 33480-3807 | 2009-12-31 |
| 1548427818 | Charles M Davis Jr. | Pharmacist | 2530 Marilyn St, Pocatello, ID 83201-8022 | 2008-05-22 |
| 1174719033 | Charles Henry Davis | Orthotist | 4859 Shed Rd, Suite 200, Bossier City, LA 71111 | 2007-09-24 |
| 1831306349 | Charles Gentry Davis Jr. | Dentist | 331 De Baliviere Ave, Saint Louis, MO 63112-1803 | 2007-05-16 |
| Street Address |
411 POLIFKA DR |
| City | SHAW AFB |
| State | SC |
| Zip Code | 29152 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275066821 | Travis B Grindstaff | General Acute Care Hospital | 411 Polifka Dr, Shaw Afb, SC 29152 | 2017-04-10 |
| 1184148553 | Daphine Lugo | Student in an Organized Health Care Education/Training Program | 411 Polifka Dr, Shaw Afb, SC 29152 | 2017-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487201695 | Ethan Lee Brockett | Dentist | Shaw Afb Dental Clinic, Shaw Afb, AE 29152 | 2019-08-22 |
| 1851791578 | Terrance Walker | Psychologist | 431 Meadow St, Sumter, SC 29152 | 2014-08-29 |
| 1124258967 | Jacqueline Mintz | Nurse Practitioner | 524 Nelson Ave, Shaw Afb, SC 29152 | 2009-07-14 |
| 1396970117 | Jennifer N Steele | Military Health Care Provider | 411 Meadowlark St, Shaw A F B, SC 29152 | 2009-05-22 |
| 1285899146 | Elizabeth Ann Vandevelde | Nurse Practitioner | 129 North Washington, Tuomey Healthcare System, Sumter, SC 29152 | 2008-07-21 |
| 1134211089 | Kibrom T Mehari | Dentist | 449 Shaw Dr, Shaw A F B, SC 29152 | 2006-09-29 |
| 1134155773 | Theresa Jean Ulichney | Registered Nurse | 420 Polifka Dr, Shaw Afb, SC 29152 | 2006-06-24 |
| 1366415184 | Kimberly Marie Shanks | Nurse Practitioner | 431 Meadowlark Rd, Shaw Afb, SC 29152 | 2006-02-10 |
| 1194710780 | Anthony Shawn Bankes | Family Medicine | 411 Medowlark, Shaw Afb, SC 29152 | 2005-09-20 |
| 1699158154 | David Nguyen | Family Medicine | 420 Polifka Dr Bldg 1042, Shaw Afb, SC 29152 | 2015-07-02 |
| Find all providers in zip 29152 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104232701 | Valerie Luisa Villanueva | Physician Assistant | 420 Polifka Dr, Shaw Afb, SC 29152-5100 | 2014-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639770712 | Hannah Jenkins | Physician Assistant | 780 Windrow Dr, Sumter, SC 29150-5318 | 2020-11-04 |
| 1255931283 | Sterling Simmons Capotosti | Physician Assistant | 1813 Joseph Cir, Florence, SC 29501-6339 | 2020-10-28 |
| 1538768098 | Hristos Stamatopoulos | Physician Assistant | 149 Independent Ln, Walterboro, SC 29488-6218 | 2020-10-25 |
| 1053910596 | Sarah Xiao Jing Jarema | Physician Assistant | 1211 Hadley Cir Unit 4301, Myrtle Beach, SC 29577-8219 | 2020-10-24 |
| 1063011062 | Sara Chmielewski | Physician Assistant | 283 Blvd De France, Parris Island, SC 29905 | 2020-10-21 |
| 1487252367 | Hannah Beddingfield | Physician Assistant | 200 Drury Ln, Mauldin, SC 29662-2228 | 2020-10-13 |
| 1275131054 | Ethan Brody Clontz | Physician Assistant | 1953 Pinehurst Ave, Charleston, SC 29414-6483 | 2020-10-13 |
| 1790383719 | Kaytlin Blake Hollingsworth | Physician Assistant | 2774 Shadow Ln, North Charleston, SC 29406-9065 | 2020-10-12 |
| 1487261509 | Reilly Kilpatrick | Physician Assistant | 1518 Blaze Ln, Charleston, SC 29412-8652 | 2020-09-24 |
| 1144836461 | Michael Joseph Haven | Physician Assistant | 221 Bayfront Dr Unit 224, Mount Pleasant, SC 29464-1825 | 2020-09-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.