Provider Demographics
NPI:1679933477
Name:EVERETT, ANDREW III
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:EVERETT
Suffix:III
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 1:1310 SOUTHERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-8105
Mailing Address - Country:US
Mailing Address - Phone:229-931-2493
Mailing Address - Fax:229-931-2963
Practice Address - Street 1:1310 SOUTHERFIELD RD
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-8105
Practice Address - Country:US
Practice Address - Phone:229-931-2493
Practice Address - Fax:229-931-2963
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health