Provider Demographics
NPI:1154387074
Name:SNYDER, AVEREL B (MD)
Entity type:Individual
Prefix:
First Name:AVEREL
Middle Name:B
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 70547
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30007-0547
Mailing Address - Country:US
Mailing Address - Phone:770-579-1894
Mailing Address - Fax:770-579-1899
Practice Address - Street 1:5665 PEACHTREE DUNWOODY ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1701
Practice Address - Country:US
Practice Address - Phone:404-252-6104
Practice Address - Fax:404-257-1808
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035769208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000508373GMedicaid
GA000508373HMedicaid
GA000508373FMedicaid
GA00508373DMedicaid
GAF33507Medicare UPIN
GA202I338296Medicare PIN
GA000508373HMedicaid
GA000508373FMedicaid