Healthcare Provider Details

I. General information

NPI: 1598029969
Provider Name (Legal Business Name): JAMES BRADLEY BECKHAM M.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 BAPTIST BLVD STE 307
COLUMBUS MS
39705-2006
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 103
MEMPHIS TN
38120-9446
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-1862
  • Fax: 662-328-7597
Mailing address:
  • Phone:
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25127
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: