Provider Demographics
NPI:1063651982
Name:PHILSON, BEVERLY LYNN (PMHCNS-BC)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:LYNN
Last Name:PHILSON
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:80 JESSE HILL JR DR , SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3801
Mailing Address - Country:US
Mailing Address - Phone:404-616-4444
Mailing Address - Fax:404-616-4737
Practice Address - Street 1:80 JESSE HILL JR DR , SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3801
Practice Address - Country:US
Practice Address - Phone:404-616-4444
Practice Address - Fax:404-616-4737
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN088054364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health