Provider Demographics
NPI:1619540556
Name:BEARD, DEWEY
Entity Type:Individual
Prefix:
First Name:DEWEY
Middle Name:
Last Name:BEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 OAKWOOD CV
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-1406
Mailing Address - Country:US
Mailing Address - Phone:662-544-3353
Mailing Address - Fax:
Practice Address - Street 1:353 OAKWOOD CV
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-1406
Practice Address - Country:US
Practice Address - Phone:662-544-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1279445172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver