MEDICARE: BEVERLY S. HARRISON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	00013602	AL

General Provider Information

NPI Number	:	1588619175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY S. HARRISON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 55059
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35255-5059
Country	:	US
Telephone Number	:	256-764-9697
Fax Number	:	256-764-9699

Provider Business Practice Location Address
First Line	:	1600 CARRAWAY BLVD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35234-1913
Country	:	US
Telephone Number	:	205-502-6817
Fax Number	:	205-502-5152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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