Provider Demographics
NPI:1942065784
Name:BEAL, BRIANNA MIKKEA (CCMA)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MIKKEA
Last Name:BEAL
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OAK ST
Mailing Address - Street 2:1413
Mailing Address - City:REIDSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30453
Mailing Address - Country:US
Mailing Address - Phone:912-322-4161
Mailing Address - Fax:
Practice Address - Street 1:120 OAK ST
Practice Address - Street 2:1413
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453
Practice Address - Country:US
Practice Address - Phone:912-322-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty