Provider Demographics
NPI:1215012695
Name:MCCRAY, BEVERLY JOYCE (NP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JOYCE
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5656 SPRING MILL CIR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4058
Mailing Address - Country:US
Mailing Address - Phone:770-808-6153
Mailing Address - Fax:404-370-7378
Practice Address - Street 1:30 WARREN ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-2267
Practice Address - Country:US
Practice Address - Phone:404-370-7360
Practice Address - Fax:404-370-7379
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN082432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner