Basic Information
| Provider Information | |||||||||
| NPI: | 1588685887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GO | ||||||||
| FirstName: | MARIE BEVERLY | ||||||||
| MiddleName: | U | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1135 SANDLER RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323179432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506562459 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1607 SAINT JAMES CT | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508780191 | ||||||||
| FaxNumber: | 8508788900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 2084P0800X | ME92722 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 20044 | TN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 055521 | GA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.