Provider Demographics
NPI:1467514703
Name:OXLEY, BEVERLY J (PHD, PC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:J
Last Name:OXLEY
Suffix:
Gender:F
Credentials:PHD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30639-0157
Mailing Address - Country:US
Mailing Address - Phone:706-246-0733
Mailing Address - Fax:706-246-0722
Practice Address - Street 1:63 SPRINGS STATION DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30639
Practice Address - Country:US
Practice Address - Phone:706-246-0733
Practice Address - Fax:706-246-0722
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2528103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA546540227AMedicaid
GA311838737OtherTAX IDENTIFICATION NUMBER