Provider Demographics
NPI:1093010548
Name:CHIN, BEVERLEY HYACINTH
Entity Type:Individual
Prefix:MS
First Name:BEVERLEY
Middle Name:HYACINTH
Last Name:CHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BEVERLEY
Other - Middle Name:HYACINTH
Other - Last Name:DINNALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:4435 BOATMANS CV
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-2483
Mailing Address - Country:US
Mailing Address - Phone:770-235-6757
Mailing Address - Fax:770-469-7825
Practice Address - Street 1:4435 BOATMANS CV
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-2483
Practice Address - Country:US
Practice Address - Phone:770-235-6757
Practice Address - Fax:770-469-7825
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082024246QM0706X
NY034875246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist