Provider Demographics
NPI:1063304368
Name:DAVENPORT, CANDACE R
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:R
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 SILVER WOOD WALK
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-5514
Mailing Address - Country:US
Mailing Address - Phone:678-571-3453
Mailing Address - Fax:678-696-5193
Practice Address - Street 1:3507 SILVER WOOD WALK
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-5514
Practice Address - Country:US
Practice Address - Phone:678-571-3453
Practice Address - Fax:678-696-5193
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care