Provider Demographics
NPI:1386645190
Name:BEALER, LAURA ALISON (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ALISON
Last Name:BEALER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1798
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-1798
Mailing Address - Country:US
Mailing Address - Phone:404-292-2500
Mailing Address - Fax:404-294-9361
Practice Address - Street 1:1457 SCOTT BLVD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:404-292-2500
Practice Address - Fax:404-294-9361
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039044207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00639867BMedicaid
GAF94040Medicare UPIN
GA18BDFCMMedicare ID - Type Unspecified