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General NPI Number Information
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NPI Number | 1932640992
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Entity Type | Individual
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Provider Name | FREDRICK M AVERY CERTIFIED PROSTHETIS
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Gender | Male
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 2900 SUTHERLAND AVE
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City | KNOXVILLE
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State | TN
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Zip | 37919-4536
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Country | US
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Telephone | 865-524-2285
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Fax | 865-971-5445
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Provider Business Mailing Address
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Address Line | 515 VILLA CREST DR
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City | KNOXVILLE
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State | TN
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Zip | 37923-6016
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Country | US
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Telephone | 865-691-7967
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Fax | 865-971-5445
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | PRO0000000036
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License Number State | TN
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