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General NPI Number Information
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NPI Number | 1811271083
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Entity Type | Individual
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Provider Name | JASNA IKANOVIC BEARD MD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 5673 PEACHTREE DUNWOODY RD STE 500
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City | ATLANTA
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State | GA
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Zip | 30342-2147
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Country | US
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Telephone | 404-251-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 5673 PEACHTREE DUNWOODY RD STE 500
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City | ATLANTA
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State | GA
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Zip | 30342-2147
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Country | US
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Telephone | 404-251-2400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 84277
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License Number State | GA
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