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General NPI Number Information
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NPI Number | 1770404733
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Entity Type | Individual
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Provider Name | AVERY THOMSON PA
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Gender | Female
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Dates
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Enumeration Date | 07/23/2026
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Last Update Date | 07/23/2026
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Provider Practice Location Address
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Address Line | 308 COLISEUM DR STE 200
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City | MACON
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State | GA
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Zip | 31217-3861
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Country | US
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Telephone | 478-742-2180
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Fax |
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Provider Business Mailing Address
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Address Line | 207 TRELLIS WALK
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City | CENTERVILLE
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State | GA
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Zip | 31028-8511
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Country | US
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Telephone | 478-508-7458
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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 | 14162
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License Number State | GA
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