Provider Demographics
NPI:1417921842
Name:GEORGIA, JEFFREY DAVENPORT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVENPORT
Last Name:GEORGIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 6369
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-6369
Mailing Address - Country:US
Mailing Address - Phone:406-495-6700
Mailing Address - Fax:406-444-2113
Practice Address - Street 1:NNMC - RADIOLOGY
Practice Address - Street 2:8901 WISCONSIN AVE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-295-4334
Practice Address - Fax:301-295-0769
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00372232085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology