Provider Demographics
NPI:1851426415
Name:STEPHEN L. AVERETT
Entity Type:Organization
Organization Name:STEPHEN L. AVERETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:AVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-589-2222
Mailing Address - Street 1:62 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-3327
Mailing Address - Country:US
Mailing Address - Phone:931-589-2222
Mailing Address - Fax:931-589-2400
Practice Address - Street 1:62 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-3327
Practice Address - Country:US
Practice Address - Phone:931-589-2222
Practice Address - Fax:931-589-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11696173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3189276Medicaid
TN3189276Medicaid
TN3716845Medicare ID - Type UnspecifiedGROUP NUMBER
TNB04372Medicare UPIN