Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT005228 | GA |
Y | 2251E1300X | Electrophysiology, Clinical | PT 005228 | GA |
NPI | 1861548281 |
---|---|
Provider Name | Andrew Ward Beach |
First Address | Macon, GA 31201-7525 |
Second Address | Macon, GA 31201-2100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 01/03/2016 |