Provider Demographics
NPI:1619908795
Name:BEVERLY, CARMEN ELIZABETH (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:ELIZABETH
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 N DEAN RD
Mailing Address - Street 2:#619
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-7638
Mailing Address - Country:US
Mailing Address - Phone:334-821-8827
Mailing Address - Fax:
Practice Address - Street 1:CAVHCS 2400 HOSPITAL RD
Practice Address - Street 2:DM CLINIC
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083
Practice Address - Country:US
Practice Address - Phone:337-727-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA494213E00000X, 213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery