Avanelle V. Jack, MD

Nephrology Physician · Brunswick, GA

Individual Active NPI

NPI number 1316996671

Practice location

208 Scranton Connector Ste 117
Brunswick, GA 31525-0560
Phone
(912) 264-5961
Fax
(912) 262-9499

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NPI record

NPI
1316996671
Entity type
Individual (Type 1)
Enumeration date
May 6, 2006
Last updated
October 24, 2017
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Nephrology Physician Primary 207RN0300X 78666 GA
Nephrology Physician 207RN0300X MD.022645 LA

Mailing address

208 Scranton Connector
Suite 117
Brunswick, GA 31525
Phone
(912) 264-5961
Fax
(912) 262-9499

About Dr. Jack

Avanelle V. Jack, MD is a healthcare provider registered in the NPI registry with the primary taxonomy Nephrology Physician (code 207RN0300X). The practice location is 208 Scranton Connector Ste 117, Brunswick, GA 31525-0560. The NPI number 1316996671 was assigned on May 6, 2006 and the record was last updated on October 24, 2017.

Dr. Jack lists 2 licenses in the registry: #78666 (GA) for Nephrology Physician; #MD.022645 (LA) for Nephrology Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Avanelle V. Jack, MD?

The NPI number is 1316996671.

What is the phone number of Dr. Jack?

The phone number listed for the practice location is (912) 264-5961.

Where is Dr. Jack located?

208 Scranton Connector Ste 117, Brunswick, GA 31525-0560.

What is the taxonomy code for Dr. Jack?

The primary taxonomy code is 207RN0300X – Nephrology Physician; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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