Healthcare Provider Details

I. General information

NPI: 1659444651
Provider Name (Legal Business Name): BEVERLY ANN GARNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N JEFFERSON ST MACON MEDICAL
MACON MS
39341-2242
US

IV. Provider business mailing address

519 7TH ST S
COLUMBUS MS
39701-6505
US

V. Phone/Fax

Practice location:
  • Phone: 662-726-5831
  • Fax:
Mailing address:
  • Phone: 662-327-6497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR767941
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: