MEDICARE: BRIANNA MIKKEA BEAL CCMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RM2200X	Medical Laboratory Technician

General Provider Information

NPI Number	:	1942065784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA MIKKEA BEAL CCMA

Provider Business Mailing Address
First Line	:	120 OAK ST
Second Line	:	1413
City	:	REIDSVILLE
State	:	GA
Zip	:	30453
Country	:	US
Telephone Number	:	912-322-4161
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 OAK ST
Second Line	:	1413
City	:	REIDSVILLE
State	:	GA
Zip	:	30453
Country	:	US
Telephone Number	:	912-322-4161
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	02/20/2024

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