Provider Demographics
NPI:1811135890
Name:LINDA K DAVENPORT MD P L L C
Entity type:Organization
Organization Name:LINDA K DAVENPORT MD P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-636-2258
Mailing Address - Street 1:411 WILSON AVE W
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-2015
Mailing Address - Country:US
Mailing Address - Phone:334-636-2258
Mailing Address - Fax:334-636-2259
Practice Address - Street 1:411 WILSON AVE W
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-2015
Practice Address - Country:US
Practice Address - Phone:334-636-2258
Practice Address - Fax:334-636-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty