Healthcare Provider Details

I. General information

NPI: 1578514980
Provider Name (Legal Business Name): JAMES LOUIS BECTON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 D'ANTIGNAC ST. SUITE 2600
AUGUSTA GA
30901-2796
US

IV. Provider business mailing address

P.O BOX 1758
EVANS GA
30809-3089
US

V. Phone/Fax

Practice location:
  • Phone: 706-854-2500
  • Fax: 706-854-2559
Mailing address:
  • Phone: 706-854-2500
  • Fax: 706-854-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number033932
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: