| Myrtle Davenport Healthcare Services Llc | |
|
200 Oxford Ln Fayetteville GA 30215-5317 | |
| (678) 203-4595 | |
| (631) 201-2695 |
| Full Name | Myrtle Davenport Healthcare Services Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 200 Oxford Ln, Fayetteville, Georgia |
| Authorized Official Name and Position | Myrtle Howard Davenport (NURSE PRACTITIONER/OWNER) |
| Authorized Official Contact | 6782034595 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Myrtle Davenport Healthcare Services Llc 200 Oxford Ln Fayetteville GA 30215-5317 Ph: (678) 203-4595 | Myrtle Davenport Healthcare Services Llc 200 Oxford Ln Fayetteville GA 30215-5317 Ph: (678) 203-4595 |
| NPI Number | 1942085832 |
|---|---|
| Provider Enumeration Date | 08/29/2023 |
| Last Update Date | 08/29/2023 |
| Certification Date | 08/29/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942085832 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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