Healthcare Provider Details

I. General information

NPI: 1932190774
Provider Name (Legal Business Name): JOHN MALCOLM BEAMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 BAY AVE.
RICHTON MS
39476
US

IV. Provider business mailing address

PO BOX 1650
RICHTON MS
39476-1650
US

V. Phone/Fax

Practice location:
  • Phone: 601-788-6321
  • Fax: 601-788-6362
Mailing address:
  • Phone: 601-788-6321
  • Fax: 601-788-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10061
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: