Davenport, Charles W.

Davenport, Charles W. is an individual health care provider with primary practice located at 1800 12Th St , Meridian MS 39301-4158. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Davenport, Charles W. can be contacted via phone (601) 703-4065.

Contact Information

Primary practice address
1800 12Th St Meridian MS 39301-4158
Phone: (601) 703-4065
Fax: (601) 703-3050
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 13521 Mississippi

Profile Details

NPI number 1851373674
LBN Legal business name Davenport, Charles W.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2005
Last updated Nov 6th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851373674 NPPES
Other 060048292 TRICARE
Other 731-02314 TRICARE
MEDICAID 00115846 TRICARE
MEDICAID 009809870 TRICARE

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