MEDICARE: DR. JENNIFER F. BEATTY D.O.

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	208600000X	Surgery Physician	212870	SC
2	208600000X	Surgery Physician	910	SC

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	:	1952387979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER F. BEATTY D.O.

Provider Business Mailing Address
First Line	:	4975 LACROSS RD STE 110
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-6531
Country	:	US
Telephone Number	:	843-797-1941
Fax Number	:	843-574-1698

Provider Business Practice Location Address
First Line	:	135 COMMONWEALTH DR STE 210
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4850
Country	:	US
Telephone Number	:	864-675-4815
Fax Number	:

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	07/24/2025

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