Provider Demographics
NPI:1710038682
Name:RESPESS, BETH (PA)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:
Last Name:RESPESS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SCRANTON CONNECTOR
Mailing Address - Street 2:SUITE 117
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0559
Mailing Address - Country:US
Mailing Address - Phone:912-264-5961
Mailing Address - Fax:
Practice Address - Street 1:208 SCRANTON CONNECTOR
Practice Address - Street 2:SUITE 117
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0559
Practice Address - Country:US
Practice Address - Phone:912-264-5961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001575363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97BBCRRMedicare ID - Type Unspecified
GAS41756Medicare UPIN