Davenport, Samuel V

Davenport, Samuel V is an individual health care provider with primary practice located at 400 N State Of Franklin Rd , Johnson City TN 37604-6035. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Davenport, Samuel V can be contacted via phone (423) 431-6111.

Contact Information

Primary practice address
400 N State Of Franklin Rd Johnson City TN 37604-6035
Phone: (423) 431-6111
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X RN0000104846 Tennessee

Profile Details

NPI number 1083616056
LBN Legal business name Davenport, Samuel V
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2005
Last updated Apr 24th, 2019 - about 5 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 1083616056 NPPES
Tennessee MEDICAID 3631202

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