| NPI | 1962906115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY DAVENPORT President/Provider 850-251-1644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 63574) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2018-03-22 |