Provider Demographics
NPI:1881981017
Name:BEASLEY, LEIGH ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:CORIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 SANDY PLAINS ROAD
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 BOULEVARD NE STE 415
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312
Practice Address - Country:US
Practice Address - Phone:404-265-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2114363A00000X
GA6172363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4410630001OtherDMERC PALMETTO
GA003116570AMedicaid
GA202I971136OtherMEDICARE PTAN