Individual
HEATHER BEASLEY TERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2785 LAWRENCEVILLE HWY, SUITE100, DECATUR, GA 30033-2515
(404) 292-4612
(678) 514-0088
Mailing address
2785 LAWRENCEVILLE HWY, SUITE100, DECATUR, GA 30033-2515
(404) 292-4612
(678) 514-0088
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
003743
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002705A
—
GA
Enumeration date
06/16/2006
Last updated
08/25/2008
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