Individual
DR. GRACE AVERITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
11714 WILSON PARKE AVE STE 150, AUSTIN, TX 78726-4061
(512) 346-6611
(512) 406-6267
Mailing address
6210 E HIGHWAY 290, AUSTIN, TX 78723-1142
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
R6333
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4031734
—
TX
05
—
403173402
—
TX
Enumeration date
05/05/2015
Last updated
01/19/2024
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