Provider Demographics
NPI:1538855283
Name:DURBIN, AVERY ANDERSON (FNP-C)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:ANDERSON
Last Name:DURBIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 WINCHESTER CIR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-3429
Mailing Address - Country:US
Mailing Address - Phone:478-787-8228
Mailing Address - Fax:
Practice Address - Street 1:4226 HARTLEY BRIDGE RD STE 103
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-4216
Practice Address - Country:US
Practice Address - Phone:478-788-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine