NPIMap

Individual provider Active NPI

Avery Callaway

  • Surgical Physician Assistant
  • Greenville, SC
National Provider Identifier
1912696956
Registry record updated Apr 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
5180 Issued in SC
Practice address
111 Doctors Dr
Greenville, SC 29605-5622
Phone
(864) 797-7150
Fax
(864) 797-7155
NPI assigned
May 4, 2023
Last updated
Apr 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Surgical Physician Assistant 363AS0400X 5180 SC Primary

Addresses

Primary practice location

111 Doctors Dr
Greenville, SC 29605-5622

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842

Other practice location 1

158 Garrett Rd
Edgefield, SC 29824-2214
Phone (803) 257-1733

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240424004134 SC Practitioner - Physician Assistant 5193165157 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

111 Doctors Dr
Greenville, SC 29605-5622
Phone (864) 797-7150

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5180SCMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Apr 20, 2026 Accepting new patients
Prisma Health University Medical Group CurrentSince Apr 20, 2026 Accepting new patients
Shriners Hospitals for Children CurrentSince Mar 2, 2024 Accepting new patients
Shriners Hospitals for Children CurrentSince Mar 2, 2024 Accepting new patients

Locations

111 Doctors Dr
Greenville, SC 29605
Phone (864) 242-4683

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

950 W Faris Rd
Greenville, SC 29605
Phone (864) 255-7941

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1683158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776643200000",
    "number": "1912696956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 DOCTORS DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296055622",
            "telephone_number": "864-797-7150",
            "fax_number": "864-797-7155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "158 Garrett Rd",
            "address_purpose": "LOCATION",
            "city": "Edgefield",
            "state": "SC",
            "postal_code": "298242214",
            "country_code": "US",
            "telephone_number": "803-257-1733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CALLAWAY",
        "first_name": "AVERY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-04",
        "last_updated": "2026-04-20",
        "certification_date": "2026-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "5180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.