Healthcare Provider Details

I. General information

NPI: 1508312521
Provider Name (Legal Business Name): BEACON HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 PEACHTREE ST NW SUITE 360
ATLANTA GA
30309-2452
US

IV. Provider business mailing address

PO BOX 54157
ATLANTA GA
30308-0157
US

V. Phone/Fax

Practice location:
  • Phone: 770-270-5229
  • Fax: 770-270-9323
Mailing address:
  • Phone: 770-270-5229
  • Fax: 770-270-9323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: LAVERNE POINDEXTER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 770-270-5229