Myrtle Davenport Healthcare Services LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

MYRTLE DAVENPORT HEALTHCARE SERVICES LLC

Practice address

200 Oxford LN
Fayetteville, GA 30215-5317

Phone

(678) 203-4595

Fax

(631) 201-2695

NPI assigned

Aug 29, 2023

Organization subpart

Yes

Parent organization

MYRTLE DAVENPORT HEALTHCARE SERVICES LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Myrtle Howard Davenport, APRN, NP-C, PMHNP-BCNPI 1710402979

Title

Nurse Practitioner/Owner

Phone

(678) 203-4595

Specialties & licenses 1

Addresses

Other names 1

• MD Behavioral and Wellness Doing business as

Part of

Myrtle Davenport Healthcare Services LLC

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Myrtle Howard Davenport, NP-C, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Stockbridge, GA
  • NPI 1710402979
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693267200000",
    "number": "1942085832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OXFORD LN",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302155317",
            "telephone_number": "678-203-4595",
            "fax_number": "631-201-2695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 OXFORD LN",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302155317",
            "telephone_number": "678-203-4595",
            "fax_number": "631-201-2695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYRTLE DAVENPORT HEALTHCARE SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MYRTLE DAVENPORT HEALTHCARE SERVICES LLC",
        "enumeration_date": "2023-08-29",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "MYRTLE",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "NURSE PRACTITIONER/OWNER",
        "authorized_official_telephone_number": "678-203-4595",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN, NP-C, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MD Behavioral and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stanley Carroll Musick, M.D.
• Joshua Mustain
• Mwamba Mwila, MD
• My Health Reassurance P.C.
• Tiffany Myrick, RBT
• Paul Agbor Naenge, MSN, APRN
• Ryan Curtis Napp, D.C.
• Kelly Nastasi
• Lateefah Nation, RD, LD
• National Medical Equipment & Supply Company LLC

• Psychiatry Physician in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.