Provider Demographics
NPI:1518555846
Name:AVERETT, DEVONTE BERNARD
Entity Type:Individual
Prefix:
First Name:DEVONTE
Middle Name:BERNARD
Last Name:AVERETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 FOUNTAIN CT APT 2206
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1632
Mailing Address - Country:US
Mailing Address - Phone:706-593-8758
Mailing Address - Fax:
Practice Address - Street 1:1700 FOUNTAIN CT APT 2206
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-1632
Practice Address - Country:US
Practice Address - Phone:706-593-8758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty