MEDICARE: SHONTRICE RENEA AVERY LMSW

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	104100000X	Social Worker	MSW011836	GA

General Provider Information

NPI Number	:	1457203283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONTRICE RENEA AVERY LMSW

Provider Business Mailing Address
First Line	:	290 M L K JR DR SE UNIT 3420
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-2493
Country	:	US
Telephone Number	:	334-401-9805
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 APPLE STREET
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312
Country	:	US
Telephone Number	:	470-222-5712
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	04/01/2026

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