Provider Demographics
NPI:1124489380
Name:BEACHAM, LAURA COLLIER
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:COLLIER
Last Name:BEACHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MICHELLE
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 870
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-5029
Mailing Address - Country:US
Mailing Address - Phone:404-255-2975
Mailing Address - Fax:404-255-2276
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 870
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-5029
Practice Address - Country:US
Practice Address - Phone:404-255-2975
Practice Address - Fax:404-255-2276
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7942363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant