1306080213 NPI number — CAROLINE E BEALL DO

Table of content: CAROLINE E BEALL DO (NPI 1306080213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306080213 NPI number — CAROLINE E BEALL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEALL
Provider First Name:
CAROLINE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306080213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 S MAIN ST STE 1300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38103-5513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-949-0108
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PROMENADE II 1230 PEACHTREE ST. NE
Provider Second Line Business Practice Location Address:
19TH FLOOR
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-3574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-949-0108
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X , with the licence number:  5101020083 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1306080213 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".