MEDICARE: BEAL WELLNESS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist
3	2084P0804X	Child & Adolescent Psychiatry Physician
4	261Q00000X	Clinic/Center
5	363A00000X	Physician Assistant
6	390200000X	Student in an Organized Health Care Education/Training Program
7	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1811494503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAL WELLNESS LLC

Provider Business Mailing Address
First Line	:	1093 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6740
Country	:	US
Telephone Number	:	404-768-2218
Fax Number	:

Provider Business Practice Location Address
First Line	:	1093 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6740
Country	:	US
Telephone Number	:	404-768-2218
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JENNIFER FIELDS
Credential	:
Telephone Number	:	404-768-2218

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	12/16/2021

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