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General NPI Number Information
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NPI Number | 1124829007
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Entity Type | Individual
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Provider Name | AVERY STEVONS
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Gender | Female
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 1483 TOBIAS GADSON BLVD STE 208
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City | CHARLESTON
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State | SC
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Zip | 29407-4796
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Country | US
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Telephone | 843-609-2309
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Fax | 843-727-8240
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Provider Business Mailing Address
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Address Line | 1280 APPLING DR UNIT 310
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-4789
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Country | US
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Telephone | 517-614-7513
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5803
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License Number State | SC
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