Healthcare Provider Details

I. General information

NPI: 1396017018
Provider Name (Legal Business Name): SHIRLEY BANNISTER AVERY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 WESTBOROUGH RD
KNOXVILLE TN
37909
US

IV. Provider business mailing address

822 WESTBOROUGH RD
KNOXVILLE TN
37909
US

V. Phone/Fax

Practice location:
  • Phone: 865-693-0875
  • Fax:
Mailing address:
  • Phone: 865-693-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD4658
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: