Provider Demographics
NPI:1508860214
Name:BEASLEY, JASON GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:GREGORY
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:606 GERALD MCRANEY ST
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-3801
Mailing Address - Country:US
Mailing Address - Phone:601-765-9393
Mailing Address - Fax:601-765-9363
Practice Address - Street 1:603 S HOLLY AVE
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-3801
Practice Address - Country:US
Practice Address - Phone:601-765-9393
Practice Address - Fax:601-765-9363
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03276372Medicaid
BB8169662OtherDEA
BB8169662OtherDEA
I14635Medicare UPIN