Provider Demographics
NPI:1881012441
Name:DAVENPORT, RUSSELL EMMETT III (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:EMMETT
Last Name:DAVENPORT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2711 RANDOLPH RD STE 207
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2027
Mailing Address - Country:US
Mailing Address - Phone:704-862-4700
Mailing Address - Fax:704-862-4789
Practice Address - Street 1:2711 RANDOLPH RD STE 207
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2027
Practice Address - Country:US
Practice Address - Phone:704-862-4700
Practice Address - Fax:704-862-4749
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2025-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2019-01531207L00000X, 207LP2900X, 208VP0000X
SC82514207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine