Provider Demographics
NPI:1841223799
Name:DAVENPORT-RAY, ROBERT BURTON (APRN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BURTON
Last Name:DAVENPORT-RAY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ALOE CT
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6215
Mailing Address - Country:US
Mailing Address - Phone:912-882-8178
Mailing Address - Fax:
Practice Address - Street 1:124 ANDREWS WAY
Practice Address - Street 2:STE B
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-1653
Practice Address - Country:US
Practice Address - Phone:912-729-7007
Practice Address - Fax:912-729-2031
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN112246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily