Provider Demographics
NPI:1912996315
Name:GERARD, BEVERLY (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:GERARD
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 1:703 LANCELOT LOOP
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-5504
Mailing Address - Country:US
Mailing Address - Phone:706-658-9032
Mailing Address - Fax:706-223-6790
Practice Address - Street 1:102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-5480
Practice Address - Country:US
Practice Address - Phone:706-782-1300
Practice Address - Fax:706-223-6790
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73437207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78755859Medicaid
E98827Medicare UPIN
TX098758805Medicaid
OK200247910 AMedicaid
TX8L15624Medicare PIN