Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 5101020083 | MI |
NPI | 1306080213 |
---|---|
Provider Name | Caroline E Beall |
First Address | Memphis, TN 38103-5513 |
Second Address | Atlanta, GA 30309-3574 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2009 |
Last Update Date | 26/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1306080213 | (05) | MI |