MEDICARE: BECKY D CARVER RN

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	163W00000X	Registered Nurse	RN106089	GA

General Provider Information

NPI Number	:	1679580898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY D CARVER RN

Provider Business Mailing Address
First Line	:	1100 WARD ST W
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31533-1902
Country	:	US
Telephone Number	:	912-389-4717
Fax Number	:	912-389-4725

Provider Business Practice Location Address
First Line	:	1100 WARD ST W
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31533-1902
Country	:	US
Telephone Number	:	912-389-4717
Fax Number	:	912-389-4725

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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