MEDICARE: GINGER SAMANTHA DAVENPORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1164212684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINGER SAMANTHA DAVENPORT

Provider Business Mailing Address
First Line	:	1327 ECHO LAKE LN
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27803-2564
Country	:	US
Telephone Number	:	252-377-2301
Fax Number	:	252-231-1649

Provider Business Practice Location Address
First Line	:	1327 ECHO LAKE LN
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27803-2564
Country	:	US
Telephone Number	:	252-377-2301
Fax Number	:	252-231-1649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	05/08/2025

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Directions to “ GINGER SAMANTHA DAVENPORT ” Practice Location

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