MEDICARE: BEVERLY BRIGGS

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		GA

General Provider Information

NPI Number	:	1861735391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY BRIGGS

Provider Business Mailing Address
First Line	:	3520 PRIMROSE CT
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-9576
Country	:	US
Telephone Number	:	706-267-1608
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 PRIMROSE CT
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-9576
Country	:	US
Telephone Number	:	706-267-1608
Fax Number	:

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

Provider Enumeration Date	:	04/03/2013
Last Update Date	:	04/03/2013

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Directions to “ BEVERLY BRIGGS ” Practice Location

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