Provider Demographics
NPI:1366437444
Name:BEIER, JESSICA WHITEHEAD (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:WHITEHEAD
Last Name:BEIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:W
Other - Last Name:LEIDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7442
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-7442
Mailing Address - Country:US
Mailing Address - Phone:229-392-1153
Mailing Address - Fax:229-353-7701
Practice Address - Street 1:901 18TH ST E
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3648
Practice Address - Country:US
Practice Address - Phone:229-392-1153
Practice Address - Fax:229-353-7701
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044378174400000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000913184AMedicaid
GA22BDDDVMedicare PIN
GAA45088Medicare UPIN