Healthcare Provider Details

I. General information

NPI: 1699632141
Provider Name (Legal Business Name): ANDREA WATKINS-DAVENPORT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 EAGLES LANDING PKWY
STOCKBRIDGE GA
30281-7247
US

IV. Provider business mailing address

909 EAGLES LANDING PKWY STE 440
STOCKBRIDGE GA
30281-6398
US

V. Phone/Fax

Practice location:
  • Phone: 478-697-3145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN315888
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP315888
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: