Healthcare Provider Details

I. General information

NPI: 1417921842
Provider Name (Legal Business Name): JEFFREY DAVENPORT GEORGIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NNMC - RADIOLOGY 8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

PO BOX 6369
HELENA MT
59604-6369
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4334
  • Fax: 301-295-0769
Mailing address:
  • Phone: 406-495-6700
  • Fax: 406-444-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0037223
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: