Healthcare Provider Details

I. General information

NPI: 1396032983
Provider Name (Legal Business Name): WALTER LEE BEARD JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 JEFFERSON ST
LAUREL MS
39440-4354
US

IV. Provider business mailing address

2124 CANDLER RD
DECATUR GA
30032-5572
US

V. Phone/Fax

Practice location:
  • Phone: 601-399-6169
  • Fax: 601-399-6184
Mailing address:
  • Phone: 404-836-0272
  • Fax: 251-435-6357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number81780
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: