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General NPI Number Information
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NPI Number | 1174018857
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Entity Type | Individual
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Provider Name | AMANDA DAVENPORT NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 100 GROSS CRESCENT CIR
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-3643
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Country | US
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Telephone | 706-858-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2504 MAPLEWOOD DR
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City | CHATTANOOGA
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State | TN
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Zip | 37421-1312
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Country | US
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Telephone | 931-247-6575
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 24402
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License Number State | TN
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