Provider Demographics
NPI:1326149139
Name:WEBB, BEREAVAL SHAMAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:BEREAVAL
Middle Name:SHAMAROL
Last Name:WEBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 VENETTA PL NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-6029
Mailing Address - Country:US
Mailing Address - Phone:404-388-2757
Mailing Address - Fax:
Practice Address - Street 1:303 PERIMETER CTR N STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-3401
Practice Address - Country:US
Practice Address - Phone:404-388-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA053964207Q00000X
GA0539642083P0500X, 207QA0401X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI40294Medicare UPIN
GA01BDHTZMedicare ID - Type UnspecifiedPROVIDER #