| C. Thomas Bevill Iii Md, Pc | |
|
12 Medical Dr Ne Cartersville GA 30121-8002 | |
| (770) 386-1000 | |
| (770) 386-9165 |
| Full Name | C. Thomas Bevill Iii Md, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 12 Medical Dr Ne, Cartersville, Georgia |
| Authorized Official Name and Position | C. Thomas Bevill (OWNER) |
| Authorized Official Contact | 7703861000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| C. Thomas Bevill Iii Md, Pc Po Box 200185 Cartersville GA 30120-9027 Ph: (770) 386-1000 | C. Thomas Bevill Iii Md, Pc 12 Medical Dr Ne Cartersville GA 30121-8002 Ph: (770) 386-1000 |
| NPI Number | 1518089820 |
|---|---|
| Provider Enumeration Date | 04/06/2007 |
| Last Update Date | 01/26/2018 |
| Medicare PECOS PAC ID | 5092704940 |
|---|---|
| Medicare Enrollment ID | O20040507000187 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518089820 | NPI | - | NPPES |
| 511I080035 | Other | GA | MEDICARE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 028143 (Georgia) | Primary |
| Provider Name | C. Thomas Bevill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619993102 PECOS PAC ID: 2567551112 Enrollment ID: I20100907000012 |
| Provider Name | J Michael Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760408272 PECOS PAC ID: 7719001296 Enrollment ID: I20100907000289 |
| Provider Name | Carisalyn Nicole Cousin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124085972 PECOS PAC ID: 6608175443 Enrollment ID: I20211028000339 |
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