Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 45720 | GA |
Y | 207Q00000X | Family Doctor | 046540 | GA |
NPI | 1003854738 |
---|---|
Provider Name | Brent Alan Beaird |
First Address | Athens, GA 30606-5700 |
Second Address | Athens, GA 30606-5700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 30/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H00714 | (02) |