Provider Demographics
NPI:1073873527
Name:BEAL, MARGIE EVLYN (FNP)
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:EVLYN
Last Name:BEAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:PINE LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30072-0294
Mailing Address - Country:US
Mailing Address - Phone:404-296-1422
Mailing Address - Fax:
Practice Address - Street 1:817 ALLGOOD RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-4803
Practice Address - Country:US
Practice Address - Phone:404-296-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145126163WP2201X, 163WP0808X, 163WH0200X
174H00000X, 372500000X, 372600000X, 3747P1801X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No174H00000XOther Service ProvidersHealth Educator
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker