Eugene Dale Beverly, MPA-C
Individual provider Active NPI Physician Assistant · Fort Gordon, GA
NPI 1861657447 · NPPES record last updated Aug 13, 2014
Key facts
- NPI
- 1861657447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 300 W Hospital Rd
Connelly Health Clinic
Fort Gordon, GA 30905-5741 - Phone
- (706) 787-5170
- NPI assigned
- Jul 23, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
300 W Hospital Rd
Connelly Health Clinic
Fort Gordon, GA 30905-5741
Mailing address
1584 Avalon Ave
Augusta, GA 30909-9803
Phone (706) 860-0867
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1025323 | Other | GA | NCCPA |
Other providers in Fort Gordon, GA
- Morgan Elizabeth Berman
- Joseph A Bernier-Rodriguez
- Joshua Berridge
- Lavonnda N. Best
- Lauren Bettencourt
- Ronald Winfield Bice
- Jennifer Bierly
- Joseph Melton Bird
- Frederick Charles Bisch
- Mary Lewis Black
All providers in Fort Gordon, GA · Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.