Healthcare Provider Details

I. General information

NPI: 1770729352
Provider Name (Legal Business Name): KARAH JAMILA BEENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2009
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 7TH ST BLDG 700
WARNER ROBINS GA
31098-2227
US

IV. Provider business mailing address

1430 1ST ST RM 1414
DOBBINS AFB GA
30069-5003
US

V. Phone/Fax

Practice location:
  • Phone: 678-655-3165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004733
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberC004733
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: