Provider Demographics
NPI:1497198865
Name:AVILA, JEREMY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SCOTT
Last Name:AVILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6799 GREAT OAKS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2572
Mailing Address - Country:US
Mailing Address - Phone:901-821-8300
Mailing Address - Fax:901-261-0718
Practice Address - Street 1:6799 GREAT OAKS RD STE 105
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-2572
Practice Address - Country:US
Practice Address - Phone:901-821-8300
Practice Address - Fax:901-261-0718
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55874208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics