Healthcare Provider Details

I. General information

NPI: 1194900944
Provider Name (Legal Business Name): KRISTIN NICOLE BEASLEY DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1093 SANDY PLAINS RD
MARIETTA GA
30066-6537
US

IV. Provider business mailing address

1093 SANDY PLAINS RD
MARIETTA GA
30066-6537
US

V. Phone/Fax

Practice location:
  • Phone: 770-424-6303
  • Fax: 770-426-4257
Mailing address:
  • Phone: 770-424-6303
  • Fax: 770-426-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVET007699
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: