Provider Demographics
NPI:1467562959
Name:BEASLEY, ERNEST WILLIAM III (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:WILLIAM
Last Name:BEASLEY
Suffix:III
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 1:975 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1619
Mailing Address - Country:US
Mailing Address - Phone:404-843-4000
Mailing Address - Fax:404-250-6701
Practice Address - Street 1:975 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1619
Practice Address - Country:US
Practice Address - Phone:404-843-4000
Practice Address - Fax:404-250-6701
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025100207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDGPNMedicare Oscar/Certification
GAD44830Medicare UPIN
11BDGPNMedicare ID - Type Unspecified