Avenue Aesthetic and Reconstructive Surgery LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

AVENUE AESTHETIC AND RECONSTRUCTIVE SURGERY LLC

Doing business as

Avenue Aesthetic and Reconstructive Surgery

Practice address

489 N Milledge Ave
Athens, GA 30601-3807

Phone

(706) 363-0256

Fax

(706) 622-4360

NPI assigned

Nov 3, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Bavani

Title

Office Manager

Phone

(706) 363-0256

Specialties & licenses 1

Addresses

Other names 1

• Avenue Aesthetic and Reconstructive Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698969600000",
    "number": "1336912021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "489 N MILLEDGE AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306013807",
            "telephone_number": "706-363-0256",
            "fax_number": "706-622-4360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 N MILLEDGE AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306013807",
            "telephone_number": "706-363-0256",
            "fax_number": "706-622-4360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVENUE AESTHETIC AND RECONSTRUCTIVE SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-03",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A",
        "authorized_official_last_name": "BAVANI",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "706-363-0256"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avenue Aesthetic and Reconstructive Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aura Morris LLC
• Frances Tucker Austin, CRNA
• Lisa Autry, ROT
• Janet Robison Avant, RN
• Erick T Avelar, MD
• Avenue Surgical Partners PC
• Ellenora E Aviles, OTRL
• Katherine Anne Avinger, PSY.D.
• Samantha Avoke, MD
• Jefferson Kodjo Awah, MD

• Medical Specialty Clinic/Center in Athens, GA
• Providers in Athens, GA by specialty
• Medical Specialty Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.