Provider Demographics
NPI:1366603557
Name:BEAULIEU, EVA ISABELLE (MD)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:ISABELLE
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 EAGLE SPRING CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7274
Mailing Address - Country:US
Mailing Address - Phone:678-616-2273
Mailing Address - Fax:
Practice Address - Street 1:130 EAGLE SPRING CT
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7274
Practice Address - Country:US
Practice Address - Phone:678-616-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine