Provider Demographics
NPI:1912996042
Name:BEAVERS, KIMBERLY LORRAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LORRAINE
Last Name:BEAVERS
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:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:520 N ELAM AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1127
Practice Address - Country:US
Practice Address - Phone:336-547-1745
Practice Address - Fax:336-547-1827
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37429207RG0100X, 207RI0008X
IN01059021A207RG0100X
NC9900013207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2011291OtherUNITED HEALTHCARE
NC126KVOtherBCBS
NC89126KVMedicaid
NC2011291OtherUNITED HEALTHCARE
NC89126KVMedicaid