Individual
DR. CHARLES W. DAVENPORT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 703-4065
(601) 703-3050
Mailing address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 703-9506
(601) 703-3264
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
13521
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115846
—
MS
05
—
009809870
—
AL
01
—
060048292
TRICARE
—
01
—
731-02314
BLUE CROSS OF AL
—
Enumeration date
11/17/2005
Last updated
11/06/2013
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