Provider Demographics
NPI:1487872552
Name:BEASLEY, STEPHANIE JUDITH (CNM,RNFA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JUDITH
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:CNM,RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 ROCKINGHAM DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1231
Mailing Address - Country:US
Mailing Address - Phone:404-376-1598
Mailing Address - Fax:404-350-0937
Practice Address - Street 1:2962 ROCKINGHAM DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1231
Practice Address - Country:US
Practice Address - Phone:404-376-1598
Practice Address - Fax:404-350-0937
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN051274 CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000635874DMedicaid