Provider Demographics
NPI:1902504582
Name:KEMP, AVERY SUZANNE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:SUZANNE
Last Name:KEMP
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 JOHNSON FERRY RD STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1630
Mailing Address - Country:US
Mailing Address - Phone:404-257-0006
Mailing Address - Fax:404-851-1316
Practice Address - Street 1:960 JOHNSON FERRY RD STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1630
Practice Address - Country:US
Practice Address - Phone:404-257-0006
Practice Address - Fax:404-851-1316
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN277577163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse