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NPI Code Detail

MEDICARE: DR. RONALD BEAUDREAU MD

MEDICARE: DR. RONALD BEAUDREAU MD
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
1207P00000XEmergency Medicine Physician042175GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356345136
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD BEAUDREAU MD
Provider Business Mailing Address
First Line : PO BOX 933049
Second Line :
City : ATLANTA
State : GA
Zip : 31193-3049
Country : US
Telephone Number : 866-313-5266
Fax Number : 205-313-5298
Provider Business Practice Location Address
First Line : 2260 WRIGHTSBORO RD
Second Line :
City : AUGUSTA
State : GA
Zip : 30904-4764
Country : US
Telephone Number : 866-313-5266
Fax Number : 205-313-5298
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 09/26/2007

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