Provider Demographics
NPI:1932722022
Name:BEAUFEAUX, DOMINIC (MED, APC)
Entity Type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:
Last Name:BEAUFEAUX
Suffix:
Gender:M
Credentials:MED, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 HIGHLAND PARK TRL
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3395
Mailing Address - Country:US
Mailing Address - Phone:928-240-3124
Mailing Address - Fax:
Practice Address - Street 1:365 NORTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-3207
Practice Address - Country:US
Practice Address - Phone:770-771-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health