MEDICARE: HEATHER BEASLEY TERRY PA

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	363AS0400X	Surgical Physician Assistant	003743	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1578507612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER BEASLEY TERRY PA

Provider Business Mailing Address
First Line	:	2785 LAWRENCEVILLE HWY
Second Line	:	SUITE100
City	:	DECATUR
State	:	GA
Zip	:	30033-2515
Country	:	US
Telephone Number	:	404-292-4612
Fax Number	:	678-514-0088

Provider Business Practice Location Address
First Line	:	2785 LAWRENCEVILLE HWY
Second Line	:	SUITE100
City	:	DECATUR
State	:	GA
Zip	:	30033-2515
Country	:	US
Telephone Number	:	404-292-4612
Fax Number	:	678-514-0088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/25/2008

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Directions to “ HEATHER BEASLEY TERRY PA” Practice Location

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