MEDICARE: THE FRATERNITY MEN'S HEALTH AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1013809482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FRATERNITY MEN'S HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	540 POWDER SPRINGS ST STE B8
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-3560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 POWDER SPRINGS ST STE B8
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-3560
Country	:	US
Telephone Number	:	404-749-0571
Fax Number	:	949-864-3686

Authorized Official
Title or Position	:	OWNER/NURSE PRACTITIONER
Name	:	MR. JOHN SIMUEL BEASLEY III
Credential	:	NP
Telephone Number	:	404-749-0571

Provider Enumeration Date	:	07/18/2025
Last Update Date	:	08/14/2025

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Directions to “THE FRATERNITY MEN'S HEALTH AND WELLNESS ” Practice Location

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