MEDICARE: AVERY JEFFREYS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant		GA

General Provider Information

NPI Number	:	1659227957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY JEFFREYS

Provider Business Mailing Address
First Line	:	608 BAYBERRY PT
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 DEPUTY BILL CANTRELL MEMORIAL RD
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040
Country	:	US
Telephone Number	:	770-292-3045
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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