Provider Demographics
NPI:1639481690
Name:BEAUDOIN, CELESTE BEARD (MD)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:BEARD
Last Name:BEAUDOIN
Suffix:
Gender:F
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:P.O. BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-382-4000
Mailing Address - Fax:864-382-4040
Practice Address - Street 1:213 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3509
Practice Address - Country:US
Practice Address - Phone:864-382-4000
Practice Address - Fax:864-382-4040
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC37136207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC371369Medicaid
SC371369Medicaid