Provider Demographics
NPI:1861695082
Name:FORD, BEVERLY BRAY (RD, LD)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:BRAY
Last Name:FORD
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6127
Mailing Address - Country:US
Mailing Address - Phone:706-589-1582
Mailing Address - Fax:
Practice Address - Street 1:1511 ANTHONY RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4821
Practice Address - Country:US
Practice Address - Phone:706-731-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD000488133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal