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NPI Code Detail

MEDICARE: AVERY GARRETT

MEDICARE: AVERY GARRETT
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1790354272
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY GARRETT
Provider Business Mailing Address
First Line : 3736 EXECUTIVE CENTER DR
Second Line :
City : AUGUSTA
State : GA
Zip : 30907-2360
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Provider Business Practice Location Address
First Line : 714 CAROLINA AVE
Second Line :
City : NORTH AUGUSTA
State : SC
Zip : 29841-3434
Country : US
Telephone Number : 706-842-5330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2021
Last Update Date : 06/21/2021

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Directions to “ AVERY GARRETT ” Practice Location

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