MEDICARE: DR. JASNA IKANOVIC BEARD 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
1	207RG0100X	Gastroenterology Physician	84277	GA

General Provider Information

NPI Number	:	1811271083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASNA IKANOVIC BEARD MD

Provider Business Mailing Address
First Line	:	5673 PEACHTREE DUNWOODY RD STE 500
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2147
Country	:	US
Telephone Number	:	404-251-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5673 PEACHTREE DUNWOODY RD STE 500
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2147
Country	:	US
Telephone Number	:	404-251-2400
Fax Number	:

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

Provider Enumeration Date	:	10/05/2011
Last Update Date	:	05/05/2020

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