Organization · NPI-2

Davenport Health PA

Family Medicine · Waycross, GA

NPI number1962906115
StatusActive
Last updated in NPPESMar 22, 2018

Details

NPI
1962906115
Entity type
Organization (NPI-2)
Legal business name
Davenport Health PA
Organization subpart
No
Enumeration date
Mar 22, 2018
Last updated
Mar 22, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine63574GAYes

Practice location

1401 Cherokee Drive
Waycross, GA 31501

Phone 850-251-1644

Mailing address

56 W. Main Street
Ste. 305
Christiana, DE 19702

Phone 302-273-2247 · Fax 302-533-6818

Authorized official

Jeffrey Davenport
President/Provider
8502511644

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