Healthcare Provider Details

I. General information

NPI: 1063651982
Provider Name (Legal Business Name): BEVERLY LYNN PHILSON PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR , SE
ATLANTA GA
30303-3801
US

IV. Provider business mailing address

80 JESSE HILL JR DR , SE
ATLANTA GA
30303-3801
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-4444
  • Fax: 404-616-4737
Mailing address:
  • Phone: 404-616-4444
  • Fax: 404-616-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN088054
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: