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General NPI Number Information
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NPI Number | 1164509667
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Entity Type | Individual
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Provider Name | JILL BEAVINS MD
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/24/2018
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Provider Practice Location Address
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Address Line | 806 JACKSON ST
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City | COLUMBUS
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State | IN
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Zip | 47201
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Country | US
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Telephone | 812-748-3412
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Fax | 812-748-3412
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Provider Business Mailing Address
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Address Line | 806 JACKSON ST
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City | COLUMBUS
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State | IN
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Zip | 47201-6264
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Country | US
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Telephone | 812-748-3412
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Fax | 812-748-3412
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01054606
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License Number State | IN
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