Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | CHIR007263 | GA |
NPI | 1528189792 |
---|---|
Provider Name | Dr. George William Beauchamp |
First Address | Duluth, GA 30096-4590 |
Second Address | Duluth, GA 30096-4590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |