Provider Demographics
NPI:1033238175
Name:HIGHLAND URGENT CARE AND FAMILY MEDICINE
Entity Type:Organization
Organization Name:HIGHLAND URGENT CARE AND FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BEAULIEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-815-1957
Mailing Address - Street 1:920 PONCE DE LEON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4212
Mailing Address - Country:US
Mailing Address - Phone:404-815-1957
Mailing Address - Fax:404-815-1954
Practice Address - Street 1:920 PONCE DE LEON AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4212
Practice Address - Country:US
Practice Address - Phone:404-815-1957
Practice Address - Fax:404-815-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG24941Medicare UPIN