Provider Demographics
NPI:1255324489
Name:BEVILL, TONY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:
Last Name:BEVILL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 JARRIELS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:GA
Mailing Address - Zip Code:30421-4806
Mailing Address - Country:US
Mailing Address - Phone:912-684-3560
Mailing Address - Fax:912-684-3615
Practice Address - Street 1:152 JARRIELS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:GA
Practice Address - Zip Code:30421-4806
Practice Address - Country:US
Practice Address - Phone:912-684-3560
Practice Address - Fax:912-684-3615
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003054363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP64238Medicare UPIN
GA97WCDLKMedicare ID - Type Unspecified