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General NPI Number Information
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NPI Number | 1699478693
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Entity Type | Individual
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Provider Name | AVERY VILLERET MD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2023
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 200 PARK CREEK DR
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City | COLUMBUS
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State | MS
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Zip | 39705-1309
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Country | US
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Telephone | 662-327-8410
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Fax | 662-327-9749
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Provider Business Mailing Address
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Address Line | 965 RIDGE LAKE BLVD STE 315
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City | MEMPHIS
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State | TN
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Zip | 38120-9401
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Country | US
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Telephone | 877-348-1281
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Fax | 901-227-3206
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | T-4951
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License Number State | MS
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