Provider Demographics
NPI:1801998943
Name:AVERY, ARNITA F (DPM)
Entity type:Individual
Prefix:
First Name:ARNITA
Middle Name:F
Last Name:AVERY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ARNITA
Other - Middle Name:FLORENCE
Other - Last Name:AVERY-KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:5825 GLENRIDGE DR
Mailing Address - Street 2:BUILDING 2, SUITE 110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5387
Mailing Address - Country:US
Mailing Address - Phone:404-255-4900
Mailing Address - Fax:404-255-4899
Practice Address - Street 1:5825 GLENRIDGE DR
Practice Address - Street 2:BUILDING 2, SUITE 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5387
Practice Address - Country:US
Practice Address - Phone:404-255-4900
Practice Address - Fax:404-255-4899
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000632208VP0000X, 213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6860OtherMEDICARE GROUP NUMBER
GA1255414520Medicare NSC
GAU16495Medicare UPIN
GA48SCBFPMedicare ID - Type UnspecifiedMEDICARE NUMBER