Individual
MR. WILLIE DAVID BEAVERS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT, GCS
Contact information
Practice address
549 COUNTRY CLUB DR, STOCKBRIDGE, GA 30281-6347
(404) 438-7445
Mailing address
549 COUNTRY CLUB DR, STOCKBRIDGE, GA 30281-6347
(404) 438-7445
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT011076
GA
2251G0304X
Geriatric Physical Therapist
Primary
PT011076
GA
Other
Enumeration date
06/23/2014
Last updated
03/17/2018
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