Basic Information
| Provider Information | |||||||||
| NPI: | 1376064121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEVIS | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | BROOKE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 HALEY ANN DR SW | ||||||||
| Address2: | |||||||||
| City: | HARTSELLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356403812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562215701 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1304 13TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356014359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563401251 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2017 | ||||||||
| LastUpdateDate: | 07/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1-091871 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.