Provider Demographics
NPI:1255983284
Name:OWENS, BEVERLI SIMONE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:BEVERLI
Middle Name:SIMONE
Last Name:OWENS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 WILLOW RUN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2425
Mailing Address - Country:US
Mailing Address - Phone:678-491-8613
Mailing Address - Fax:
Practice Address - Street 1:918 WILLOW RUN
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-2425
Practice Address - Country:US
Practice Address - Phone:678-491-8613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0036462255A2300X
FLAL72922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer