Healthcare Provider Details

I. General information

NPI: 1669524898
Provider Name (Legal Business Name): GEORGIA E BEWAYO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GARRETT AVENUE
LA PLATA MD
20646-4010
US

IV. Provider business mailing address

4639 DIAMOND RIDGE LN
WHITE PLAINS MD
20695-3103
US

V. Phone/Fax

Practice location:
  • Phone: 301-539-5100
  • Fax: 301-934-2084
Mailing address:
  • Phone: 301-396-5753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1106110
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR179194
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: