Provider Demographics
NPI:1366089773
Name:AVERETT, DENISE MICHELLE (CEO)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:AVERETT
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 GUNBOAT DR STE 33
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-1498
Mailing Address - Country:US
Mailing Address - Phone:706-888-0155
Mailing Address - Fax:
Practice Address - Street 1:5401 GUNBOAT DR STE 33
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-1498
Practice Address - Country:US
Practice Address - Phone:706-888-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor