Provider Demographics
NPI:1134581283
Name:EVERETT, ANDREW EDWARD (MD (ANTICIPATED))
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:EDWARD
Last Name:EVERETT
Suffix:
Gender:M
Credentials:MD (ANTICIPATED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 947381
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7381
Mailing Address - Country:US
Mailing Address - Phone:386-231-4529
Mailing Address - Fax:386-672-9904
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 300
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5170
Practice Address - Country:US
Practice Address - Phone:386-231-3600
Practice Address - Fax:386-231-3605
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-27
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME165116208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty