Provider Demographics
NPI:1184195653
Name:BEASLEY, JOHN SIMUEL III (NP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SIMUEL
Last Name:BEASLEY
Suffix:III
Gender:M
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:55 WHITCHER ST NE STE 250
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1169
Mailing Address - Country:US
Mailing Address - Phone:770-428-4475
Mailing Address - Fax:770-426-1499
Practice Address - Street 1:55 WHITCHER ST NE STE 250
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1169
Practice Address - Country:US
Practice Address - Phone:770-428-4475
Practice Address - Fax:770-426-1499
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN197645363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner