Provider Demographics
NPI:1760140917
Name:AVERY MAE PEDIATRICS LLC
Entity Type:Organization
Organization Name:AVERY MAE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-988-7810
Mailing Address - Street 1:2100 BRANFORD PL STE 301
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-1010
Mailing Address - Country:US
Mailing Address - Phone:615-988-7810
Mailing Address - Fax:
Practice Address - Street 1:2100 BRANFORD PL STE 301
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-1010
Practice Address - Country:US
Practice Address - Phone:615-261-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty