1811448970 NPI number — MS. JESSICA LEIGH BEATTIE N.P.

Table of content: MS. JESSICA LEIGH BEATTIE N.P. (NPI 1811448970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811448970 NPI number — MS. JESSICA LEIGH BEATTIE N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEATTIE
Provider First Name:
JESSICA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
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:
1811448970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 OAK HILL BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NEWNAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30265-2314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-400-8400
Provider Business Mailing Address Fax Number:
770-400-8401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 OAK HILL BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NEWNAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30265-2314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-400-8400
Provider Business Practice Location Address Fax Number:
770-400-8401
Provider Enumeration Date:
10/24/2016

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: 363LF0000X , with the licence number:  RN214299 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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