Healthcare Provider Details

I. General information

NPI: 1922445659
Provider Name (Legal Business Name): JONATHAN BEUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 02/17/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

1001 JOHNSON FY RD NE
ATLANTA GA
30342-1605
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-4826
  • Fax: 404-785-4820
Mailing address:
  • Phone: 404-785-4826
  • Fax: 404-785-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number88752
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: