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General NPI Number Information
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NPI Number | 1952387979
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Entity Type | Individual
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Provider Name | JENNIFER F. BEATTY D.O.
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Gender | Female
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 135 COMMONWEALTH DR STE 210
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City | GREENVILLE
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State | SC
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Zip | 29615-4850
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Country | US
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Telephone | 864-675-4815
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Fax |
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Provider Business Mailing Address
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Address Line | 4975 LACROSS RD STE 110
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-6531
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Country | US
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Telephone | 843-797-1941
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Fax | 843-574-1698
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 212870
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 910
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License Number State | SC
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