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General NPI Number Information
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NPI Number | 1841223799
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Entity Type | Individual
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Provider Name | ROBERT BURTON DAVENPORT-RAY APRN
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 124 ANDREWS WAY STE B
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City | SAINT MARYS
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State | GA
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Zip | 31558-1653
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Country | US
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Telephone | 912-729-7007
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Fax | 912-729-2031
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Provider Business Mailing Address
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Address Line | 100 ALOE CT
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City | KINGSLAND
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State | GA
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Zip | 31548-6215
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Country | US
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Telephone | 912-882-8178
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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 | RN112246
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License Number State | GA
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