Healthcare Provider Details

I. General information

NPI: 1205387453
Provider Name (Legal Business Name): AVERY PARTNERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SW 258TH ST
NEWBERRY FL
32669-4133
US

IV. Provider business mailing address

1805 OLD ALABAMA RD SUITE 200
ROSWELL GA
30076-2259
US

V. Phone/Fax

Practice location:
  • Phone: 352-474-6111
  • Fax:
Mailing address:
  • Phone: 770-642-6100
  • Fax: 678-367-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. AL MEIVES IV
Title or Position: VP OUTPATIENT SERVICES
Credential: PT
Phone: 859-585-3002