MEDICARE: MS. BEVERLY LYNN PHILSON PMHCNS-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	RN088054	GA

General Provider Information

NPI Number	:	1063651982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY LYNN PHILSON PMHCNS-BC

Provider Business Mailing Address
First Line	:	80 JESSE HILL JR DR , SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-3801
Country	:	US
Telephone Number	:	404-616-4444
Fax Number	:	404-616-4737

Provider Business Practice Location Address
First Line	:	80 JESSE HILL JR DR , SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-3801
Country	:	US
Telephone Number	:	404-616-4444
Fax Number	:	404-616-4737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2009
Last Update Date	:	02/17/2009

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