Provider Demographics
NPI:1033764162
Name:AVERY JAMES LLC
Entity Type:Organization
Organization Name:AVERY JAMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-727-2211
Mailing Address - Street 1:4725 REIGER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1254
Mailing Address - Country:US
Mailing Address - Phone:214-727-2211
Mailing Address - Fax:
Practice Address - Street 1:6330 BROADWAY BLVD STE C
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5956
Practice Address - Country:US
Practice Address - Phone:214-728-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty