Individual
BIBOMBA DAVENPORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2690 MT WILKINSON PKWY SE, 22, SMYRNA, GA 30080-3020
(404) 510-2604
Mailing address
2690 MT WILKINSON PKWY SE, 22, SMYRNA, GA 30080
(404) 510-2604
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
1744P3200X
GA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
10/23/2013
Last updated
05/31/2023
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