AVERY CAMILLE CHISHOLM MD NPI 1558824912

NPI Information

  • NPI: 1558824912
  • Provider Name: AVERY CAMILLE CHISHOLM, MD
  • Classification: Internal Medicine - 207RG0100X
  • Specialization: Gastroenterology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 462626 STATE ROAD 200 STE 300
    YULEE, FL
    ZIP 32097
  • Phone: (904) 398-7205

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NPI Details

Avery Camille Chisholm, MD is a gastroenterology internal medicine in Yulee, FL. The provider is an internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. Avery Camille Chisholm, MD NPI is 1558824912. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

462626 STATE ROAD 200 STE 300
YULEE, FL
ZIP 32097-516
Phone: (904) 398-7205

The NPI 1558824912 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/11/2019 and was last updated on 10/7/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RG0100XInternal MedicineGastroenterologyME175195FLORIDAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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