MEDICARE: DEVONTE BERNARD AVERETT

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	174400000X	Specialist
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1518555846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVONTE BERNARD AVERETT

Provider Business Mailing Address
First Line	:	1700 FOUNTAIN CT APT 2206
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-1632
Country	:	US
Telephone Number	:	706-593-8758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 FOUNTAIN CT APT 2206
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-1632
Country	:	US
Telephone Number	:	706-593-8758
Fax Number	:

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

Provider Enumeration Date	:	01/03/2021
Last Update Date	:	01/19/2021

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Directions to “ DEVONTE BERNARD AVERETT ” Practice Location

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