Provider Demographics
NPI:1386376945
Name:BEAMER, TANYA
Entity type:Individual
Prefix:MISS
First Name:TANYA
Middle Name:
Last Name:BEAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 HAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-8732
Mailing Address - Country:US
Mailing Address - Phone:803-361-4389
Mailing Address - Fax:
Practice Address - Street 1:265 HAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-8732
Practice Address - Country:US
Practice Address - Phone:803-361-4389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC007718868347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle