Provider Demographics
NPI:1043844285
Name:AVAKOV, VALERIE (MA)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:AVAKOV
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 PREMIER DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-2916
Mailing Address - Country:US
Mailing Address - Phone:615-939-7029
Mailing Address - Fax:
Practice Address - Street 1:6505 PREMIER DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-2916
Practice Address - Country:US
Practice Address - Phone:615-939-7029
Practice Address - Fax:615-930-3729
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTD533109653Medicaid