Provider Demographics
NPI:1558111286
Name:BEAMON, SHANTAL L
Entity Type:Individual
Prefix:
First Name:SHANTAL
Middle Name:L
Last Name:BEAMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-1657
Mailing Address - Country:US
Mailing Address - Phone:229-305-4183
Mailing Address - Fax:
Practice Address - Street 1:707 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-1657
Practice Address - Country:US
Practice Address - Phone:229-305-4183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker