Provider Demographics
NPI:1174852313
Name:AVERY, HATTIE DENISE
Entity Type:Individual
Prefix:MISS
First Name:HATTIE
Middle Name:DENISE
Last Name:AVERY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:AVERY
Other - Last Name:ONUMONU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:834 GINGER CT B
Mailing Address - Street 2:
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905
Mailing Address - Country:US
Mailing Address - Phone:706-814-8509
Mailing Address - Fax:706-910-0422
Practice Address - Street 1:834 GINGER CT APT B
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-4095
Practice Address - Country:US
Practice Address - Phone:706-814-8509
Practice Address - Fax:706-910-0422
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246YC3302XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationCoding Specialist, Physician Office Based