Provider Demographics
NPI:1710022777
Name:AVRITT, PAMELA R (DC)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:R
Last Name:AVRITT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PAM
Other - Middle Name:R
Other - Last Name:AVRITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:430 HAMPTON AVE
Mailing Address - Street 2:P.O. BOX 604
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-2608
Mailing Address - Country:US
Mailing Address - Phone:864-878-8190
Mailing Address - Fax:
Practice Address - Street 1:430 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2608
Practice Address - Country:US
Practice Address - Phone:864-878-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC57-0994664OtherGROUP TAX ID
SCGCH236Medicaid