MEDICARE: JOSHUA G DAVENPORT PA-C

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	363AM0700X	Medical Physician Assistant	4477	TN
2	363A00000X	Physician Assistant	0110008873	VA
3	363A00000X	Physician Assistant	4477	TN
4	363AM0700X	Medical Physician Assistant	0110008873	VA

General Provider Information

NPI Number	:	1982297180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA G DAVENPORT PA-C

Provider Business Mailing Address
First Line	:	477 N CHANCERY ST # 5
Second Line	:
City	:	MCMINNVILLE
State	:	TN
Zip	:	37110-8901
Country	:	US
Telephone Number	:	931-365-2175
Fax Number	:	615-893-9969

Provider Business Practice Location Address
First Line	:	249 CENTRAL PARK AVENUE
Second Line	:	SUITE 300-161
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3099
Country	:	US
Telephone Number	:	615-994-1000
Fax Number	:	615-994-0100

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

Provider Enumeration Date	:	02/18/2021
Last Update Date	:	06/01/2026

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