Healthcare Provider Details

I. General information

NPI: 1740321496
Provider Name (Legal Business Name): GLENDA BEERMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MISTY RIDGE MNR NW
ATLANTA GA
30327-4978
US

IV. Provider business mailing address

2 MISTY RIDGE MNR NW
ATLANTA GA
30327-4978
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-6762
  • Fax: 404-252-5018
Mailing address:
  • Phone: 404-255-6762
  • Fax: 404-252-5018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN137810
License Number StateGA

VIII. Authorized Official

Name: GLENDA BEERMAN
Title or Position: OWNER
Credential: RNFA
Phone: 404-255-6762