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General NPI Number Information
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NPI Number | 1801942552
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Entity Type | Individual
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Provider Name | BEVERLY D. ROSEBERRY APRN
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 1733 LAKE ROCKAWAY RD NW
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City | CONYERS
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State | GA
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Zip | 30012-3152
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Country | US
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Telephone | 404-748-4123
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Fax | 866-340-9148
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Provider Business Mailing Address
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Address Line | PO BOX 4715 ATLANTA
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City | ATLANTA
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State | GA
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Zip | 30302-4715
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Country | US
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Telephone | 404-748-4123
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Fax | 866-340-9148
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | RN065472
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License Number State | GA
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