Provider Demographics
NPI:1801867981
Name:DAVENPORT, PAMELA N (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:N
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:100 E WOOD ST
Practice Address - Street 2:SUITE 401
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3004
Practice Address - Country:US
Practice Address - Phone:864-560-6851
Practice Address - Fax:864-560-7312
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14833207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6906258Medicaid
SC148334Medicaid
SC4238873OtherAETNA
SC62581OtherMEDCOST
SC148334Medicaid
SCE38771Medicare UPIN
SCE387713365Medicare PIN
NC6906258Medicaid
SC110123649Medicare PIN