Individual
LISA F. BEVILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCD,CCC-A
Contact information
Practice address
540 HEMLOCK ST, MACON, GA 31201-3202
(478) 743-8953
(478) 743-1963
Mailing address
540 HEMLOCK ST, MACON, GA 31201-3202
(478) 743-8953
(478) 743-1963
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
—
—
231HA2400X
Assistive Technology Practitioner Audiologist
—
GA
231HA2500X
Assistive Technology Supplier Audiologist
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000767214A
—
GA
Enumeration date
06/04/2006
Last updated
12/15/2009
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