Beverly, Eugene Dale

Beverly, Eugene Dale is an individual health care provider with primary practice located at 300 W Hospital Rd Connelly Health Clinic, Fort Gordon GA 30905-5741. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Beverly, Eugene Dale can be contacted via phone (706) 787-5170.

Contact Information

Primary practice address
300 W Hospital Rd Connelly Health Clinic Fort Gordon GA 30905-5741
Phone: (706) 787-5170
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X

Profile Details

NPI number 1861657447
LBN Legal business name Beverly, Eugene Dale
Credentials MPA-C
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 23rd, 2008
Last updated Aug 13th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861657447 NPPES
Georgia Other 1025323 NCCPA

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