Healthcare Provider Details

I. General information

NPI: 1104800663
Provider Name (Legal Business Name): WILLIAM JOHNSTON BEARD III D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 05/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 BIRMINGHAM HWY BLDG 100
MILTON GA
30004-4186
US

IV. Provider business mailing address

12220 BIRMINGHAM HWY BLDG 100
MILTON GA
30004-4186
US

V. Phone/Fax

Practice location:
  • Phone: 770-664-5600
  • Fax:
Mailing address:
  • Phone: 770-664-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9221
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: