Active NPI
Charles L Davenport Jr.
- Pharmacist
- Mableton, GA
National Provider Identifier
1104038686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- GA017346
- Practice address
- 558 Ivey Way S.E.
Mableton, GA 30126 - Phone
- (678) 575-8701
- NPI assigned
- May 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | GA017346 | GA | Primary |
Addresses
Primary practice location
558 Ivey Way S.E.
Mableton, GA 30126
Mailing address
558 Ivey Way S.E.
Mableton, GA 30126
Phone (678) 575-8701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GA017346 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104038686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "558 IVEY WAY S.E.",
"city": "MABLETON",
"state": "GA",
"postal_code": "30126",
"telephone_number": "678-575-8701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "558 IVEY WAY S.E.",
"city": "MABLETON",
"state": "GA",
"postal_code": "30126",
"telephone_number": "678-575-8701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVENPORT",
"first_name": "CHARLES",
"middle_name": "L",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "GA017346",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mableton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.