Provider Demographics
NPI:1396032983
Name:BEARD, WALTER LEE JR (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:LEE
Last Name:BEARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2124 CANDLER RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-5572
Mailing Address - Country:US
Mailing Address - Phone:404-836-0272
Mailing Address - Fax:251-435-6357
Practice Address - Street 1:2124 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-5572
Practice Address - Country:US
Practice Address - Phone:404-836-0272
Practice Address - Fax:251-435-6357
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81780207RC0000X, 207RC0000X
FLME132982207RC0000X
ALMD.36054207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA81780OtherMEDICAL LICENSE
FLME132982OtherMEDICAL LICENSE
FL021429400Medicaid
ALMD.36054OtherMEDICAL LICENSE
MST-2403OtherMS TEMPORARY MEDICAL LICENSE