Healthcare Provider Details

I. General information

NPI: 1982297180
Provider Name (Legal Business Name): JOSHUA G DAVENPORT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 CENTRAL PARK AVENUE SUITE 300-161
VIRGINIA BEACH VA
23462-3099
US

IV. Provider business mailing address

477 N CHANCERY ST # 5
MCMINNVILLE TN
37110-8901
US

V. Phone/Fax

Practice location:
  • Phone: 615-994-1000
  • Fax: 615-994-0100
Mailing address:
  • Phone: 931-365-2175
  • Fax: 615-893-9969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4477
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110008873
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4477
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110008873
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: