Healthcare Provider Details

I. General information

NPI: 1053625178
Provider Name (Legal Business Name): BEVERLY KAY SNYDER-DESALLES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY MAILSTOP 313
AUGUSTA GA
30904-6258
US

IV. Provider business mailing address

1 FREEDOM WAY MAILSTOP 313
AUGUSTA GA
30904-6258
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax: 706-823-1788
Mailing address:
  • Phone: 706-733-0188
  • Fax: 706-823-1788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN168003
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: