Provider Demographics
NPI:1538393905
Name:BEASLEY, THOMAS BASS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BASS
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5480 GOODMAN RD STE 3
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7902
Practice Address - Country:US
Practice Address - Phone:662-893-9815
Practice Address - Fax:662-893-9888
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52023208600000X
MS23320208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01440718OtherRAILROAD MEDICARE
MS00276815Medicaid
TN6020201OtherBCBS
TNQ008144Medicaid
TNQ008144Medicaid