Tanjala Davenport

NPI #1295201127 in Valdosta, Georgia

Provider Information

NPI Number: 1295201127
Entity Type: Individual
Name: Tanjala Davenport
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Contractor
Enumeration Date: Oct 18, 2018
Last Updated: Oct 18, 2018

Practice Location

Address: 811 W MARY ST APT B1
City: Valdosta
State: Georgia
ZIP Code: 31601-3781
Phone: (229) 630-5146

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Contractor	171W00000X	Primary

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