Healthcare Provider Details

I. General information

NPI: 1861659567
Provider Name (Legal Business Name): GEORGIA BEASLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GEORGIA BEASLEY

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 STONEYBROOK DR
DURHAM NC
27705-2400
US

IV. Provider business mailing address

3812 STONEYBROOK DR
DURHAM NC
27705-2400
US

V. Phone/Fax

Practice location:
  • Phone: 919-812-4397
  • Fax: 919-419-8810
Mailing address:
  • Phone: 919-812-4397
  • Fax: 919-419-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number2017-00134
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: