Individual
MRS. LEIGH ANN BEASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
285 BOULEVARD NE STE 415, ATLANTA, GA 30312
(404) 265-4400
Mailing address
805 SANDY PLAINS ROAD, MEDICAL STAFF SERVICES, MARIETTA, GA 30066-6340
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2114
GA
363AS0400X
Surgical Physician Assistant
Primary
6172
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003116570A
—
GA
01
—
202I971136
MEDICARE PTAN
GA
01
—
4410630001
DMERC PALMETTO
GA
Enumeration date
07/08/2011
Last updated
11/06/2019
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