Provider Demographics
NPI:1235864547
Name:AVERETT MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:AVERETT MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-589-2222
Mailing Address - Street 1:62 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-3327
Mailing Address - Country:US
Mailing Address - Phone:931-589-2222
Mailing Address - Fax:
Practice Address - Street 1:62 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-3327
Practice Address - Country:US
Practice Address - Phone:931-589-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health