Provider Demographics
NPI:1720010978
Name:BEALL, VIRGIL EMMITT (MD)
Entity Type:Individual
Prefix:
First Name:VIRGIL
Middle Name:EMMITT
Last Name:BEALL
Suffix:
Gender:M
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:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-0768
Mailing Address - Country:US
Mailing Address - Phone:770-217-5111
Mailing Address - Fax:800-410-0311
Practice Address - Street 1:1240 JESSE JEWELL PKWY SE
Practice Address - Street 2:SUITE 250
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3862
Practice Address - Country:US
Practice Address - Phone:770-217-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034293207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000465065AAMedicaid
GA05BDJHG01Medicare ID - Type Unspecified
GA05BDJHGMedicare ID - Type Unspecified
E88091Medicare UPIN
GA050078210Medicare Oscar/Certification