Healthcare Provider Details

I. General information

NPI: 1003017526
Provider Name (Legal Business Name): TANYA DENISE BECKFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 HIGHWAY 54 W SUITE 220
FAYETTEVILLE GA
30214-4550
US

IV. Provider business mailing address

1279 HIGHWAY 54 W SUITE 220
FAYETTEVILLE GA
30214-4550
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-2200
  • Fax: 770-716-8672
Mailing address:
  • Phone: 770-991-2200
  • Fax: 770-716-8672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number060703
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number244284
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: