MR. ANTOINE JOSE DAVENPORT (NPI# 1790044907) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790044907 |
| Entity Type | Individual |
| Full Name | MR. ANTOINE JOSE DAVENPORT |
| Credential | KINESIOTHERAPIST,LMT |
| Practice Address |
4686 Jamerson Creek Dr Marietta GA 30066 |
| Mailing Address |
4686 Jamerson Creek Dr Marietta GA 30066-1123 |
| Practice Telephone | 4049666400 |
| Mailing Telephone | 4049666400 |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2019-06-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | MT011484 | GA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 226300000X | Kinesiotherapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 224Y00000X | Clinical Exercise Physiologist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 172M00000X | Mechanotherapist | LMT011484 | GA | Other Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1755 Grassland Pkwy, Suite B, Alpharetta, GA 300048600 | 6875801404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659916179 | Antoine Davenport | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5326 | 2019-11-07 |
| Street Address |
4686 JAMERSON CREEK DR |
| City | MARIETTA |
| State | GA |
| Zip Code | 30066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598253684 | Comfort Community Center, LLC | Skilled Nursing Facility | 2440 Sandy Plains Road, Blvd 21, Suite 100, Marietta, GA 30066 | 2018-04-25 |
| 1538681994 | Passionate Care | In Home Supportive Care | 1110 Renfro Ln., Marietta, GA 30066 | 2017-07-07 |
| 1437510443 | Steven Caras | Internal Medicine | 2682 Bonaire Terrace, Marietta, GA 30066 | 2016-03-18 |
| 1275918781 | Latifat Bolajoko Asemota | Nurse Practitioner | 410 Nottingham Dr, Marietta, GA 30066 | 2015-07-26 |
| 1497094205 | Changing Phases Behavioral Support, Inc | Internal Medicine | 3655 Canton Rd Ste 201, Marietta, GA 30066 | 2013-02-14 |
| 1659618916 | Alison Nicole Sims | Occupational Therapist | 2465 Canopy Drive, Marietta, GA 30066 | 2013-01-07 |
| 1174898548 | Angel Elizabeth Nofziger | Nurse Practitioner | 3750 Palladian Village Dr Ste 300, Marietta, GA 30066 | 2012-03-18 |
| 1912298019 | Nancy Jean Slack | Pharmacist | 2833 Canton Road, Marietta, GA 30066 | 2011-04-22 |
| 1336456078 | Mario B Miller Sr. | Chiropractor | 50 Barrett Parkway, Suite 3005#126, Marietta, GA 30066 | 2010-09-01 |
| 1619121837 | America's Best Contacts & Eyeglasses | Technician/Technologist | 50 Ernest W. Barrett Pkwy, Ste. 1500, Marietta, GA 30066 | 2008-11-14 |
| Find all providers in zip 30066 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437764313 | Alan Atogamis De Souza | Massage Therapist | 2359 Windy Hill Rd Se Ste 320, Marietta, GA 30067-8660 | 2020-09-09 |
| 1578175055 | Lucretia Benee Vinson | Massage Therapist | 2575 Whitehaven Dr Sw Ste 121, Marietta, GA 30064-4569 | 2020-08-17 |
| 1740800192 | Patricia Taylor | Massage Therapist | 2123 Favor Rd Sw Apt 8, Marietta, GA 30060-4769 | 2020-04-24 |
| 1154955631 | Carlene Croney | Massage Therapist | 3002 Kingston Ct Se, Marietta, GA 30067-8957 | 2020-02-24 |
| 1811529225 | Octavia Elayne Mckenney | Massage Therapist | 3577 Main Station Dr Sw, Marietta, GA 30008-6054 | 2020-02-04 |
| 1861030694 | Linda Nordahl | Massage Therapist | 145 Church St Ne Ste 103, Marietta, GA 30060-1691 | 2019-12-11 |
| 1376197764 | Tracey E Moody | Massage Therapist | 1838 Blackwater Dr, Marietta, GA 30066-6712 | 2019-07-24 |
| 1558839126 | April Denise Mills | Massage Therapist | 4875 Olde Towne Pkwy Ste 50, Marietta, GA 30068-5632 | 2018-11-12 |
| 1497264527 | Lakisha Gaines | Massage Therapist | 349 Alexander Cir Se, Marietta, GA 30060-2238 | 2017-09-20 |
| 1700317724 | Bria Dailey | Massage Therapist | 4645 Kempton Pl Ne, Marietta, GA 30067-3642 | 2017-03-22 |
| Find all providers in MARIETTA | ||||
Please comment or provide details below to improve the information on MR. ANTOINE JOSE DAVENPORT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.