Healthcare Provider Details

I. General information

NPI: 1568282382
Provider Name (Legal Business Name): JORDAN BEASLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 PEACHTREE DUNWOODY RD STE 820
ATLANTA GA
30342-4717
US

IV. Provider business mailing address

1117 MAPLE RIDGE CT
EVANS GA
30809-5249
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-1998
  • Fax:
Mailing address:
  • Phone: 706-836-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN287126
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberRN287126
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberRN287126
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN287126
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN287126
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: