Healthcare Provider Details

I. General information

NPI: 1386616209
Provider Name (Legal Business Name): EVERETT LELAND PERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 BAXTER ST
ATHENS GA
30606-3712
US

IV. Provider business mailing address

3036 OCONEE SPRINGS DR
STATHAM GA
30666-3642
US

V. Phone/Fax

Practice location:
  • Phone: 706-389-3000
  • Fax:
Mailing address:
  • Phone: 706-206-8392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number056872
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number056872
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: