MEDICARE: AVERY JAMES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1033764162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERY JAMES LLC

Provider Business Mailing Address
First Line	:	4725 REIGER AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1254
Country	:	US
Telephone Number	:	214-727-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 BROADWAY BLVD STE C
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-5956
Country	:	US
Telephone Number	:	214-728-2211
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KEVIN HANN
Credential	:
Telephone Number	:	214-727-2211

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	08/06/2019

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Directions to “AVERY JAMES LLC ” Practice Location

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