Provider Demographics
NPI:1659409845
Name:CARR, AVERY Q
Entity Type:Individual
Prefix:DR
First Name:AVERY
Middle Name:Q
Last Name:CARR
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:AVERY
Other - Middle Name:Q
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2136 STONEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2922
Mailing Address - Country:US
Mailing Address - Phone:770-920-0067
Mailing Address - Fax:
Practice Address - Street 1:2403 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-4141
Practice Address - Country:US
Practice Address - Phone:205-562-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU94106Medicare UPIN