Individual
MR. EUGENE DALE BEVERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPA-C
Contact information
Practice address
300 W HOSPITAL RD, CONNELLY HEALTH CLINIC, FORT GORDON, GA 30905-5741
(706) 787-5170
Mailing address
1584 AVALON AVE, AUGUSTA, GA 30909-9803
(706) 860-0867
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1025323
NCCPA
GA
Enumeration date
07/23/2008
Last updated
08/13/2014
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