Provider Demographics
NPI:1801806484
Name:BEAUMONT, JAMES (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:BEAUMONT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 PHOENIX BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5545
Mailing Address - Country:US
Mailing Address - Phone:770-909-6550
Mailing Address - Fax:770-909-6551
Practice Address - Street 1:1631 PHOENIX BLVD STE 5
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5545
Practice Address - Country:US
Practice Address - Phone:770-909-6550
Practice Address - Fax:770-909-6551
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002571103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical