Healthcare Provider Details

I. General information

NPI: 1063512390
Provider Name (Legal Business Name): STEPHEN L AVERETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 MEDICAL DR
LINDEN TN
37096-3327
US

IV. Provider business mailing address

62 MEDICAL DR
LINDEN TN
37096-3327
US

V. Phone/Fax

Practice location:
  • Phone: 931-589-2222
  • Fax: 931-589-2400
Mailing address:
  • Phone: 931-589-2222
  • Fax: 931-589-2400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number11696
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11696
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: