Healthcare Provider Details

I. General information

NPI: 1114105152
Provider Name (Legal Business Name): CONNIE LEE BEARDSLEY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 NUTT RD
FRANKLIN GA
30217-4855
US

IV. Provider business mailing address

2295 NUTT RD
FRANKLIN GA
30217-4855
US

V. Phone/Fax

Practice location:
  • Phone: 706-675-3936
  • Fax:
Mailing address:
  • Phone: 706-675-3936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN105913
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: