Active NPI
Mandy Conner Davenport, PHARMD
- Pharmacist
- Statesboro, GA
National Provider Identifier
1457511446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH021364
- Practice address
- 603 Northside Dr W
Statesboro, GA 30458-5378 - Phone
- (912) 764-8241
- Fax
- (912) 489-4818
- NPI assigned
- Jun 12, 2008
- Sex
- Female
- Sole proprietor
- No
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 | RPH021364 | GA | Primary |
Addresses
Primary practice location
603 Northside Dr W
Statesboro, GA 30458-5378
Mailing address
603 Northside Dr W
Statesboro, GA 30458-5378
Phone (912) 764-8241
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH021364 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279497600000",
"number": "1457511446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "603 NORTHSIDE DR W",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304585378",
"telephone_number": "912-764-8241",
"fax_number": "912-489-4818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "603 NORTHSIDE DR W",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304585378",
"telephone_number": "912-764-8241",
"fax_number": "912-489-4818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVENPORT",
"first_name": "MANDY",
"middle_name": "CONNER",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-12",
"last_updated": "2010-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH021364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.