Organization
CLINTON S. BEVERLY MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLINTON S BEVERLY M.D. (OWNER)
(478) 477-3112
Entity
Organization
Contact information
Practice address
440 CHARTER BLVD, SUITE 3302, MACON, GA 31210-4857
(478) 477-3112
(478) 477-4840
Mailing address
PO BOX 4047, MACON, GA 31208-4047
(478) 477-3112
(478) 477-4840
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC0201
RAIL ROAD MEDICARE GRP #
GA
Enumeration date
11/10/2006
Last updated
08/22/2020
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