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Organization

DRIVEN FROM WITHIN

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MICHAH DAVENPORT (CEO/FOUNDER)
(678) 755-5580
Entity
Organization

Contact information

Practice address
1377 IVEY POINTE DR, LAWRENCEVILLE, GA 30045-2647
(678) 755-5580
Mailing address
1377 IVEY POINTE DR, LAWRENCEVILLE, GA 30045-2647
(678) 755-5580

Taxonomy

Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
305R00000X
Preferred Provider Organization

Other

Enumeration date
04/25/2013
Last updated
04/25/2013
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