Davenport Health PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

63574 Issued in GA

Legal business name

DAVENPORT HEALTH PA

Practice address

1401 Cherokee Drive
Waycross, GA 31501

Phone

(850) 251-1644

NPI assigned

Mar 22, 2018

Organization subpart

No

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

Authorized official

Name

Jeffrey Davenport, MD

Title

President/Provider

Phone

(850) 251-1644

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1521676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521676800000",
    "number": "1962906115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 W. MAIN STREET",
            "address_2": "STE. 305",
            "city": "CHRISTIANA",
            "state": "DE",
            "postal_code": "19702",
            "telephone_number": "302-273-2247",
            "fax_number": "302-533-6818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 CHEROKEE DRIVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "31501",
            "telephone_number": "850-251-1644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVENPORT HEALTH PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-22",
        "last_updated": "2018-03-22",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT/PROVIDER",
        "authorized_official_telephone_number": "850-251-1644",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "63574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Waycross, GA
• Providers in Waycross, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2018; 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.