Provider Demographics
NPI:1740256585
Name:BEAN, JAMES E JR (PA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:BEAN
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3400 OLD MILTON PKWY # C
Mailing Address - Street 2:STE 290
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-667-4337
Mailing Address - Fax:770-667-4338
Practice Address - Street 1:3400C OLD MILTON PKWY STE 290
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4438
Practice Address - Country:US
Practice Address - Phone:770-667-4343
Practice Address - Fax:770-772-0937
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA002592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA743682526CMedicaid
GA743682526GMedicaid
GA743682526BMedicaid
GA743682526DMedicaid
GA743682526HMedicaid
GA743682526IMedicaid
GA743682526GMedicaid
GA743682526DMedicaid