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NPI Code Detail

MEDICARE: DR. ROBERT O BEVERIDGE MD

MEDICARE: DR. ROBERT O BEVERIDGE MD
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
1207Q00000XFamily Medicine Physician87394GA
2390200000XStudent in an Organized Health Care Education/Training ProgramGA
3207Q00000XFamily Medicine Physician01087310AIN

General Provider Information

NPI Number : 1538621453
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT O BEVERIDGE MD
Provider Business Mailing Address
First Line : 500 W 3RD AVE STE 101
Second Line :
City : ALBANY
State : GA
Zip : 31701-1900
Country : US
Telephone Number : 229-312-5802
Fax Number :
Provider Business Practice Location Address
First Line : 2336 DAWSON RD STE 1500
Second Line :
City : ALBANY
State : GA
Zip : 31707-2802
Country : US
Telephone Number : 229-312-8800
Fax Number : 229-312-8895
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2019
Last Update Date : 03/25/2022

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