MEDICARE: WILLIAM WAYNE DAVENPORT M.D.

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	2085R0202X	Diagnostic Radiology Physician	76325	GA
2	2085R0202X	Diagnostic Radiology Physician	E-4365	AR
3	174400000X	Specialist	E4365	AR
4	2085N0700X	Neuroradiology Physician	E-4365	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	E4365	OTHER	AR	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952391401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM WAYNE DAVENPORT M.D.

Provider Business Mailing Address
First Line	:	582 ISLAND WALK E
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-7834
Country	:	US
Telephone Number	:	501-815-4924
Fax Number	:

Provider Business Practice Location Address
First Line	:	582 ISLAND WALK E
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-7834
Country	:	US
Telephone Number	:	501-815-4924
Fax Number	:

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	05/26/2026

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