Individual
TIMOTHY C DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
145 INNOVATION DR, STE 300, JACKSON, TN 38305-3019
(731) 422-0213
(731) 422-0402
Mailing address
PO BOX 400, JACKSON, TN 38302-0400
(731) 425-5752
(731) 425-5783
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
45054
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1514816
—
TN
01
—
4231017
BCBS NUMBER
TN
Enumeration date
03/20/2008
Last updated
10/25/2023
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