Provider Demographics
NPI:1942006952
Name:DAVIS, WAYNE (LIC EXTERMINATOR)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:
Credentials:LIC EXTERMINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OAK HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-4698
Mailing Address - Country:US
Mailing Address - Phone:803-968-0670
Mailing Address - Fax:
Practice Address - Street 1:15 OAK HAVEN CT
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-4698
Practice Address - Country:US
Practice Address - Phone:803-968-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCA033212405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional