# DR. AVIT JOHN GREMILLION III

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1861479529
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 023984 | LA | — |
| 207W00000X | Ophthalmology Physician | 17239 | MS | Yes |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | 023984 | LA | — |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | 17239 | MS | — |

## Other

- **Enumeration date:** 12/23/2005
- **Last updated:** 12/05/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 05109145 | — | MS |
| 05 | — | 05109745 | — | MS |
| 05 | — | 1486787 | — | LA |
| 01 | — | 180000355 | MEDICARE RAILROAD | MS |
| 01 | — | 7812033 | AETNA | MS |