MEDICARE: ERNEST W. BEASLEY, JR, MD, PC

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	006755	GA

General Provider Information

NPI Number	:	1720023393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERNEST W. BEASLEY, JR, MD, PC

Provider Business Mailing Address
First Line	:	5667 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 150
City	:	ATLANTA
State	:	GA
Zip	:	30342-1725
Country	:	US
Telephone Number	:	404-843-2001
Fax Number	:	404-843-3411

Provider Business Practice Location Address
First Line	:	5667 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 150
City	:	ATLANTA
State	:	GA
Zip	:	30342-1725
Country	:	US
Telephone Number	:	404-843-2001
Fax Number	:	404-843-3411

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ERNEST WILLIAM BEASLEY JR.
Credential	:	MD
Telephone Number	:	404-843-2001

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/22/2020

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