Healthcare Provider Details

I. General information

NPI: 1609908912
Provider Name (Legal Business Name): BEVERLY ELIZABETH CORRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 W BUFORD ST
GAFFNEY SC
29341-1102
US

IV. Provider business mailing address

1621 W BUFORD ST
GAFFNEY SC
29341-1102
US

V. Phone/Fax

Practice location:
  • Phone: 864-488-9247
  • Fax:
Mailing address:
  • Phone: 864-488-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11686
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: