Healthcare Provider Details

I. General information

NPI: 1033238175
Provider Name (Legal Business Name): HIGHLAND URGENT CARE AND FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 PONCE DE LEON AVE NE
ATLANTA GA
30306-4212
US

IV. Provider business mailing address

920 PONCE DE LEON AVE NE
ATLANTA GA
30306-4212
US

V. Phone/Fax

Practice location:
  • Phone: 404-815-1957
  • Fax: 404-815-1954
Mailing address:
  • Phone: 404-815-1957
  • Fax: 404-815-1954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS JEAN BEAULIEU
Title or Position: DOCTOR
Credential: M.D.
Phone: 404-815-1957