Provider Demographics
NPI:1578685376
Name:BEATY, TAMARA CHRISTIANNE (DC)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:CHRISTIANNE
Last Name:BEATY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 LIMESTONE PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2097
Mailing Address - Country:US
Mailing Address - Phone:770-287-7100
Mailing Address - Fax:
Practice Address - Street 1:2458 LIMESTONE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2097
Practice Address - Country:US
Practice Address - Phone:770-287-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28628111N00000X
CA28628111N00000X
GACHIRO09477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0286280Medicare UPIN