Healthcare Provider Details

I. General information

NPI: 1366496903
Provider Name (Legal Business Name): MARY MARGARET BEAUCHAMP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY MARGARET ROBICHAUX

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 MARTHA BERRY BLVD NW
ROME GA
30165-1625
US

IV. Provider business mailing address

221 TECHNOLOGY PKWY NW
ROME GA
30165-1369
US

V. Phone/Fax

Practice location:
  • Phone: 706-295-5331
  • Fax: 706-236-6491
Mailing address:
  • Phone: 762-235-1000
  • Fax: 706-236-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number056960
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: