Healthcare Provider Details

I. General information

NPI: 1730322389
Provider Name (Legal Business Name): JAMES ROBERT DAVENPORT M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 LIGHT HALL
NASHVILLE TN
37212
US

IV. Provider business mailing address

2146 BELCOURT AVE VMG BUSINESS OFFICE
NASHVILLE TN
37212
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-4916
  • Fax:
Mailing address:
  • Phone: 615-945-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number48117
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: