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NPI Code Detail

MEDICARE: AVITA MEDICAL CENTER LLC

MEDICARE: AVITA MEDICAL CENTER 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
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1659230126
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVITA MEDICAL CENTER LLC
Provider Business Mailing Address
First Line : 3662 HUDDLESTONE LN
Second Line :
City : BUFORD
State : GA
Zip : 30519-4650
Country : US
Telephone Number : 305-733-9554
Fax Number :
Provider Business Practice Location Address
First Line : 3525 SUGARLOAF PKWY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-5403
Country : US
Telephone Number : 305-927-9101
Fax Number :
Authorized Official
Title or Position : PRACTICE MANAGER
Name : JHONJERLYN MORALES
Credential :
Telephone Number : 305-733-9554
Provider Enumeration Date : 01/20/2026
Last Update Date : 01/20/2026

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Directions to “AVITA MEDICAL CENTER LLC ” Practice Location

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