Individual
WILLIAM WAYNE DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
582 ISLAND WALK E, MT PLEASANT, SC 29464-7834
(501) 815-4924
Mailing address
582 ISLAND WALK E, MT PLEASANT, SC 29464-7834
(501) 815-4924
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
E4365
AR
2085N0700X
Neuroradiology Physician
E-4365
AR
2085R0202X
Diagnostic Radiology Physician
Primary
76325
GA
2085R0202X
Diagnostic Radiology Physician
E-4365
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157517001
—
AR
01
—
E4365
STATE LICENSE
AR
Enumeration date
10/26/2005
Last updated
03/07/2023
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