Healthcare Provider Details

I. General information

NPI: 1083296453
Provider Name (Legal Business Name): AVERY THOMSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 JOHNSTON MEMORIAL DR STE 100
ABINGDON VA
24211-7664
US

IV. Provider business mailing address

16000 JOHNSTON MEMORIAL DR STE 100
ABINGDON VA
24211-7664
US

V. Phone/Fax

Practice location:
  • Phone: 276-477-1443
  • Fax: 276-477-1441
Mailing address:
  • Phone: 276-477-1443
  • Fax: 276-477-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301461
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: