MR. WILLIE DAVID BEAVERS III (NPI# 1336554955) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336554955 |
| Entity Type | Individual |
| Full Name | MR. WILLIE DAVID BEAVERS III |
| Credential | PT, DPT, GCS |
| Practice Address |
549 Country Club Dr Stockbridge GA 30281-6347 |
| Practice Telephone | 4044387445 |
| Mailing Telephone | 4044387445 |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | PT011076 | GA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 2251G0304X |
Physical Therapist Specialization: Geriatrics |
PT011076 | GA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1670 Clairmont Rd, Main Hospital, Room 1c 232, Decatur, GA 300334004 | 4043216111 |
| Street Address |
549 COUNTRY CLUB DR |
| City | STOCKBRIDGE |
| State | GA |
| Zip Code | 30281-6347 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679186175 | Brittany Hayes | Chore Provider | 549 Country Club Dr, Stockbridge, GA 30281-6347 | 2020-08-25 |
| 1972092955 | Georgia Geriatrics and Rehabilitation | Physical Therapist | 549 Country Club Dr, Stockbridge, GA 30281-6347 | 2018-05-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164039095 | Colette Alls | Social Worker | 447 Lakeshore Dr, Stockbridge, GA 30281 | 2020-09-24 |
| 1982216800 | Pediatric and Family Behavioral Health of Georgia | Counselor | 1004 Ulster Court, Stockbridge, GA 30281 | 2020-08-21 |
| 1518577659 | Qunique Taveka Toxey | Behavior Technician | 115 N Park Trail, Suite 123, Stockbridge, GA 30281 | 2020-08-04 |
| 1497377675 | Melanie Harvey | Pharmacist | 4467 North Henry Boulevard, Stockbridge, GA 30281 | 2020-05-11 |
| 1114550571 | Cecile Maria Dunkley Layne | Counselor | 255 Corporte Drive, Stockbridge, GA 30281 | 2020-02-13 |
| 1306407143 | Palliative Care of Georgia. LLC | Home Health | 275 Corporate Center Court Ste C, Stockbridge, GA 30281 | 2019-06-24 |
| 1154883791 | Aaliyah Nura Fardan-alexander | Nurse's Aide | 105 Singletree, Stockbridge, GA 30281 | 2019-04-02 |
| 1306306261 | Prosthetic Care, Inc. | Prosthetic/Orthotic Supplier | 150 County Club Drive, Suite 200, Stockbridge, GA 30281 | 2019-03-25 |
| 1356814172 | Kristina Louissaint | Nurse Practitioner | 650 Country Club Dr, Stockbridge, GA 30281 | 2019-01-03 |
| 1942789284 | Cameren Barnes | Physical Therapist | 5473 N Henry Blvd, Stockbridge, GA 30281 | 2018-08-08 |
| Find all providers in zip 30281 | ||||
| Taxonomy Code | 2251G0304X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Geriatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972092955 | Georgia Geriatrics and Rehabilitation | Physical Therapist | 549 Country Club Dr, Stockbridge, GA 30281-6347 | 2018-05-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457952509 | Stephanie Miller | Physical Therapist | 313 Furys Ferry Rd, Martinez, GA 30907-3001 | 2020-11-05 |
| 1861965204 | Tamphamani Chiragkumar Patel | Physical Therapist | 1235 Briers Creek Dr, Alpharetta, GA 30004-7116 | 2019-01-08 |
| 1356818652 | Excelarate Physical Therapy | Physical Therapist | 216 Harrison Ln, Brunswick, GA 31520-1959 | 2018-10-25 |
| 1851832430 | Jennifer Williams | Physical Therapist | 4999 Presley Mill Rd, Douglasville, GA 30135 | 2017-03-15 |
| 1316482755 | Corinthias Burnett | Physical Therapist | 7090 Arbor Pkwy Apt 1427, Douglasville, GA 30135-1583 | 2016-12-20 |
| 1124407929 | Jennifer Anne Upham X | Physical Therapist | 4216 Bridlecreek Dr Nw, Acworth, GA 30101-3872 | 2015-05-26 |
| 1801138540 | Terri Coley | Physical Therapist | 5357 Mccaghren Dr, Columbus, GA 31909-4184 | 2013-03-20 |
| 1578809174 | Marjorie Pomeroy Baker | Physical Therapist | 223 S Crawford St, Thomasville, GA 31792-5504 | 2012-12-31 |
| 1730377169 | Penny Wright | Physical Therapist | 1981 Sandcreek Dr Sw, Atlanta, GA 30331-8404 | 2007-10-10 |
| 1558583773 | Seetal J Deluca | Physical Therapist | 3581 Braselton Hwy, Dacula, GA 30019-1027 | 2007-05-03 |
| Find all providers with the same taxonomy | ||||
| City | STOCKBRIDGE |
| Zip Code | 30281 |
Please comment or provide details below to improve the information on MR. WILLIE DAVID BEAVERS III.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.