Beverly Pottinger Pickens, D.O.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

052002 Issued in GA

Practice address

6095 Professional Pkwy
Suite A210
Douglasville, GA 30134-5607

Phone

(770) 949-4188

Fax

(770) 949-1614

NPI assigned

Oct 10, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1932297868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6095 PROFESSIONAL PKWY",
            "address_2": "SUITE A210",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345607",
            "telephone_number": "770-949-4188",
            "fax_number": "770-949-1614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6095 PROFESSIONAL PKWY",
            "address_2": "SUITE A210",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345607",
            "telephone_number": "770-949-4188",
            "fax_number": "770-949-1614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTINGER PICKENS",
        "first_name": "BEVERLY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "052002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "811423149A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bpottingerpickens32640@directwellstar.org",
            "affiliation": "N",
            "address_1": "6095 Professional Pkwy",
            "address_2": "SUITE A210",
            "city": "Douglasville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301345607",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.