Healthcare Provider Details

I. General information

NPI: 1174074777
Provider Name (Legal Business Name): AVERY PARTNERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 WATSON BLVD
WARNER ROBINS GA
31093-3633
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 478-742-0904
  • Fax:
Mailing address:
  • Phone: 770-642-6100
  • Fax: 678-367-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

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