Provider Demographics
NPI:1447293428
Name:AVERY, KAREN (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 SPRINGHILL CT
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-1402
Mailing Address - Country:US
Mailing Address - Phone:205-490-6322
Mailing Address - Fax:205-490-6322
Practice Address - Street 1:5870 HIGHWAY 153 STE 122
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5826
Practice Address - Country:US
Practice Address - Phone:423-243-3342
Practice Address - Fax:423-402-8155
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18557207P00000X
AL27405207P00000X
TN542302083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS202011213OtherBLUE CROSS
MS01402598Medicaid
MS202011213OtherBLUE CROSS
MSI28871Medicare UPIN