Healthcare Provider Details

I. General information

NPI: 1578883302
Provider Name (Legal Business Name): AMANDA SUE DAVENPORT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA SUE THOMPSON M.D.

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GORDON GUTMANN BLVD SUITE 201
JEFFERSONVILLE IN
47130-3764
US

IV. Provider business mailing address

301 GORDON GUTMANN BLVD STE 201
JEFFERSONVILLE IN
47130-3766
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-6114
  • Fax: 812-280-2142
Mailing address:
  • Phone: 812-282-6114
  • Fax: 812-650-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number47103
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: