Jack, Avanelle V

Jack, Avanelle V is an individual health care provider with primary practice located at 208 Scranton Connector Ste 117 , Brunswick GA 31525-0560. She recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as her primary health care specialty. Jack, Avanelle V can be contacted via phone (912) 264-5961.

Contact Information

Primary practice address
208 Scranton Connector Ste 117 Brunswick GA 31525-0560
Phone: (912) 264-5961
Fax: (912) 262-9499
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X MD.022645 Louisiana
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 78666 Georgia

Profile Details

NPI number 1316996671
LBN Legal business name Jack, Avanelle V
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 6th, 2006
Last updated Oct 24th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1316996671 NPPES
Louisiana MEDICAID 1491501

Popular Providers