Healthcare Provider Details

I. General information

NPI: 1720023393
Provider Name (Legal Business Name): ERNEST W. BEASLEY, JR, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5667 PEACHTREE DUNWOODY RD NE SUITE 150
ATLANTA GA
30342-1725
US

IV. Provider business mailing address

5667 PEACHTREE DUNWOODY RD NE SUITE 150
ATLANTA GA
30342-1725
US

V. Phone/Fax

Practice location:
  • Phone: 404-843-2001
  • Fax: 404-843-3411
Mailing address:
  • Phone: 404-843-2001
  • Fax: 404-843-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number006755
License Number StateGA

VIII. Authorized Official

Name: DR. ERNEST WILLIAM BEASLEY JR.
Title or Position: OWNER
Credential: MD
Phone: 404-843-2001