Provider Demographics
NPI:1275807026
Name:BEALL, ADAM HARRISON (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:HARRISON
Last Name:BEALL
Suffix:
Gender:M
Credentials:MD
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 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-6810
Mailing Address - Fax:864-224-1109
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE 2500
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-512-6810
Practice Address - Fax:864-224-1109
Is Sole Proprietor?:No
Enumeration Date:2012-02-25
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35746208600000X
FLME113977208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC357465Medicaid
SCSC12347111Medicare PIN