Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 494 | GA |
N | 222Z00000X | Podiatrist | 494 | GA |
N | 213EP1101X | Primary Podiatric Medicine | 494 | GA |
N | 213ES0131X | Foot Surgery | 494 | GA |
NPI | 1619908795 |
---|---|
Provider Name | Dr. Carmen Elizabeth Beverly |
First Address | Auburn, AL 36830-7638 |
Second Address | Tuskegee, AL 36083 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |