Provider Demographics
NPI:1386044584
Name:AVERETT HEALTHCARE LLC
Entity Type:Organization
Organization Name:AVERETT HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:AVERETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:706-442-6394
Mailing Address - Street 1:PO BOX 1091
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-1091
Mailing Address - Country:US
Mailing Address - Phone:706-442-6394
Mailing Address - Fax:706-221-8649
Practice Address - Street 1:6303 ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3053
Practice Address - Country:US
Practice Address - Phone:706-442-6394
Practice Address - Fax:706-221-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health